Young patient’s age determines pterygium recurrence after surgery

Anguria, Peter; Ntuli, Sam; Carmichael, Trevor

doi:10.4314/ahs.v14i1.11

Cited by 14 publications

(11 citation statements)

References 14 publications

(17 reference statements)

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“…Others fail to establish such a relationship. 17 18 32 42 Samadi et al showed in their case series that the vertical size of the pterygium more than 6.7 mm is a risk factor for recurrence. 17 Kim et al also confirmed the same finding.…”

Section: R Esultsmentioning

confidence: 99%

“… 43 In contrast, in a prospective study of 190 patients, larger preoperative size of the pterygium was confirmed as a protective factor against recurrence following CAU or limbal conjunctival autograft (LCAU) surgeries. 18 It is important to mention that published studies in this aspect differ substantially not only in methodological aspects but also in their observation period, the usage of adjuvant medication, sample size, and measuring approach. 17 Anguria et al did not show an association between the fleshiness of pterygium and recurrence.…”

Section: R Esultsmentioning

confidence: 99%

“…Incomplete control of postoperative inflammation, surgical techniques such as excessive suturing and incomplete removal of the primary pterygium, young age, surgeon experience, higher morphologic grade (fleshiness of pterygium), heavy vascularization of the primary pterygium, and black race are other risk factors for recurrence of the pterygium. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 In addition, the precise pathogenesis of recurrence is under debate. Also, basic science studies have shown that changes in the limbal stem cells and fibroblasts have a role in pterygium formation and pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Recurrent pterygium: A review

et al. 2021

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Purpose: To summarize the recent evidence regarding different aspects of pterygium recurrence. Methods: Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Results: Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-ﬂuorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Conclusions: There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.

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Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent pterygium: A review

et al. 2021

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“…Cryotherapy is used in the treatment of relatively small and thin pterygia to destroy and atrophy new blood vessels [4]. However, surgical excision is the main treatment for pterygium, although the recurrence rates after simple excision are as high as 30.0%∼88.9% [5]. Revealing the mechanism of pterygium recurrence and how to reduce the recurrence rate has become the topics of considerable focus.…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors

Guo

Xiao

Cui

et al. 2019

Journal of Ophthalmology

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A pterygium is generally believed to be a chronic inflammatory lesion caused by external stimuli that develops from the conjunctiva and grows onto the cornea. Simple bare sclera excision is the most commonly used method to treat pterygium. However, the high postoperative recurrence rate of pterygium remains a persistent challenge. Mitomycin C (MMC) is an antineoplastic antibiotic that inhibits DNA, RNA, and protein synthesis. In recent years, although MMC has proven useful for the treatment of pterygium, its application has been controversial because of its clear toxicity and the possibility of ocular complications. In the current study, we prospectively recruited patients to receive or not receive a local injection of MMC (0.4 mg/ml). Follow-up was conducted with the patients to determine the postoperative recurrence rate of pterygium and/or to observe any ocular complications. The remarkable results demonstrated that MMC can decrease the postoperative recurrence rate of pterygium without leading to serious eye complications. Further results indicated that MMC can inhibit the activation of the NLRP3 inflammatory signalling pathway and thus downregulate the expression of downstream molecules, including IL-18 and IL-1β. MMC also reduced the expression of inflammatory factors TGF-β1, VEGF, and IL-6. In addition to influencing these factors, MMC suppressed neovascularization and the proliferation of corneal fibroblasts to effectively reduce the recurrence rate of pterygium. Taken together, our results provide a theoretical basis for the development of prevention and treatment strategies for pterygium and suggest that MMC is highly effective as an adjunctive treatment after excision of primary pterygia.

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“…Male gender as a predictive factor, however, seemed inconclusive as there have been mixed results in multiple studies. 1,17,28,38,39 Younger age has been documented to be more prone towards recurrence in a few studies. 1,38,40 Surprisingly, our study contradicts this, possibly due to an uneven distribution number of patients whereby most of the patients in our study were more than 60 years old.…”

Section: Discussionmentioning

confidence: 99%

Recurrent pterygium in Bintulu, Sarawak (Malaysian Borneo): determining its risk factors

Murugia

Chong

Lim

et al. 2021

MyJO

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Introduction: Pterygium may give rise to astigmatism in addition to causing blindness in advanced stages, reflecting the importance of timely surgical intervention. Despite various operative approaches, the recurrence rate continues to range from 2% to 89%. Therefore, it is essential to investigate the risk factors influencing recurrence to improve therapeutic strategies. Purpose: To determine the risk factors of pterygium recurrence among the multiethnic cohort of patients in Bintulu, Sarawak (Malaysian Borneo). Study design: Retrospective cohort. Materials and methods: This study was conducted in Bintulu Hospital, Sarawak and involved patients who underwent pterygium excision with conjunctival autografting between April 1, 2016 and May 31, 2019. Patients completed at least a year of follow-up for recurrence detection. Collected data included presence of recurrence, sociodemographics, outdoor activities, habits, first-degree family history, pterygium type and location, as well as laterality. Chi-squared test, Fisher’s exact test, and logistic regression analysis were used. Results: A total of 161 eyes that underwent pterygium excision in 137 patients were identified. Percentage of recurrence was 42%. Mean age during excision was 59.3 ± 11.5 years; age group showed no significance in pterygium recurrence (p = 0.447). Male gender showed statistical significance (p = 0.045, OR 1.90, CI 1.01, 3.58) in chi-squared test but not in logistic regression. Ethnicity, marital status, income, and education level showed no association with recurrence (p > 0.05). Anatomic factors like location (p = 0.353) and laterality (p = 0.955) also showed no association. Smoking (p = 0.867) and alcohol intake (p = 0.397) were insignificant, similar to first-degree family history (p = 0.137). Activities involving sun exposure (p < 0.001, OR 18.34, 95% CI 5.59, 60.17) and recurrent pterygium type (p = 0.001, OR 7.40, 95% CI 1.81, 30.21) supported a positive association with recurrence. Medication adherence (p < 0.001, OR 3.61, 95% CI 1.07, 12.21) and the use of sun protection (p < 0.001, OR 7.90, 95% CI 3.25, 19.19) showed a statistically significant decrease in recurrence. Conclusion: Activities involving sun exposure, use of sun protection, medication adherence, and recurrent pterygium type have shown to be statistically significant in influencing pterygium recurrence.

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Young patient’s age determines pterygium recurrence after surgery

Cited by 14 publications

References 14 publications

Recurrent pterygium: A review

Recurrent pterygium: A review

Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors

Recurrent pterygium in Bintulu, Sarawak (Malaysian Borneo): determining its risk factors

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