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Purpose: To evaluate and analyze the outcomes of sutureless and glue?free limbal?conjunctival autografting in cases of primary as well as recurrent pterygium. Methods: This prospective interventional study was carried out between February 2019 and February 2020 at a tertiary care hospital in North India. A total of 70 patients with pterygium underwent sutureless and glue?free limbal?conjunctival autograft. The patients were divided into two groups: group 1 patients with primary pterygium (n = 45), group 2 patients with recurrent pterygium (n = 25). The patients were followed up till 12 months postoperatively. Results: The mean age of the patients in group 1 and group 2 was 37.04 ± 8.69 years and 32.52 ± 6.49 years, respectively (P = 0.04). Postoperatively, no recurrence was recorded in group 1. Recurrence was noticed in two patients (8%) of group 2. The BCVA changed from 78.73 ± 9.86 letters to 80.15 ± 7.29 letters (P = 0.45) and from 79.6 ± 6.44 letters to 79.8 ± 5.86 letters (P = 0.45) in group 1 and group 2, respectively. Graft edema was found in seven (15.55%) cases of group 1 and four (16%) cases of group 2. Graft retraction was found in two (4.44%) cases of group 1 and three (12%) cases of group 2. Conclusion: Sutureless and a glue?free limbal?conjunctival autograft is a safe and effective treatment option for primary as well as recurrent pterygium.
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AIM: To compare the analysis of conjunctival autograft(CAG)or limbal conjunctival autograft(LCAG)for treating pterygium.METHODS: Systematic search of the National Library of America Medical Literature Search System(PubMed), the Excerpta Medica Database(EMBASE), the Cochrane Library and the US Clinical Trial Registry which all literatures established of the database from September 2021. The rate of recurrence, corneal epithelial healing time, the change in Schirmer Ⅰ test(SⅠt)and the change in tear break-up time(BUT)were analyzed. Statistical analysis was performed using Review Manager 5.3, count data were expressed as relative ratio(RR),measurement data were expressed as standardized mean difference(SMD)with 95%CI.RESULTS: There were 15 studies included with a total number of 1 883 surgical eyes,among them, there were 897 eyes experienced LCAG while 986 eyes underwent CAG. For the rate of recurrence, LCAG group was lower than CAG group(RR=0.33, 95%CI: 0.15-0.71, P=0.004). For corneal epithelial healing time, LCAG group seemed to behave better than CAG group(SMD=-0.87, 95%CI: -1.64 to -0.11, P = 0.02). No statistical significance was found for SⅠt(SMD = 0.03, 95% CI, -0.33-0.40, P=0.86)and as for BUT, LACG group showed longer times against CAG group(SMD=0.40, 95%CI: 0.09-0.70, P=0.01).CONCLUSIONS: Pterygium resection combined with LCAG was with lower recurrence rate, faster corneal epithelial healing and more stable tear film rather than CAG.
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@#AIM: To analyze the influence of limbal conjunctival autograft and amniotic membrane transplantation on vision, corneal astigmatism(CAD)and tear film function in patients undergo pterygium surgery.<p>METHODS: Totally 96 patients(96 eyes)who had undergone pterygium surgery in the Department of Ophthalmology at Pengzhou People's Hospital were enrolled in this retrospective study between August 2018 and March 2020. According to random number table method, the patients were divided into observation group(48 patients with 48 eyes treated with pterygium excision combined with limbal conjunctival autograft)and control group(48 patients with 48 eyes treated with pterygium excision combined with amniotic membrane transplantation). General surgical indicators, uncorrected visual acuity(UCVA), tear film function \〖break-up time(BUT), SⅠt\〗, CAD, ocular surface disease index(OSDI), recurrence rate and incidence of complications were compared between the two groups.<p>RESULTS: The surgical time of observation group was longer than that of the control group, and the corneal epithelial healing time was shorter than that of the control group(<i>P</i><0.001). There was no significant difference in hospital stay or conjunctival hyperemia and edema remission time between the two groups(<i>P</i> >0.05). The UCVA of the two groups increased at 1, 3 and 6mo after surgery(<i>P</i><0.05), without statistically significant difference between groups(<i>P</i> >0.05). Compared with pre-operation, the BUT and SⅠt of both groups also increased, while CAD and OSDI scores decreased at 1, 3 and 6mo after surgery(<i>P</i><0.05). Besides, the BUT and SⅠt of observation group at 1mo after surgery were shorter/lower than control group, which were longer/higher than control group at 3 and 6mo after surgery(<i>P</i><0.05). However, there was no significant difference in CAD between the two groups(<i>P</i> >0.05). OSDI scores of the observation group were lower than those of the control group at 1, 3 and 6mo after surgery(<i>P</i><0.05). The recurrence rate of observation group within 6mo after surgery was lower than that of control group(<i>P</i><0.05), but the difference in incidence of complications was not significant(<i>P</i>>0.05).<p>CONCLUSION: Compared with amniotic membrane transplantation, limbal conjunctival autograft combined with pterygium excision applied in treatment of patients with pterygium can significantly shorten the corneal epithelial healing time, and reduce the influence on tear film function and recurrence rate, without affecting vision and corneal astigmatism. It is also safe and reliable.
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@#AIM: To compare the effects of tear film after conjunctival autograft transplant(CAT)and limbal conjunctival autograft transplant(LCAT)for primary pterygium.<p>METHODS: In a prospective study, 150 patients(150 eyes)diagnosed with primary pterygium were collected in Beijing road medical area of Xinjiang Military Region General Hospital from September 2018 to May 2019. The 150 patients enrolled in the study in turn, and divided into two groups by the odd and even number. The odd number underwent CAT and the even number underwent LCAT. Respectively before surgery and 1, 3, 6mo and 1a after surgery, tear film break-up time(TBUT), SchirmerⅠtest(SⅠt)and ocular surface disease index(OSDI)were checked. The date were compared and analyzed.<p>RESULTS:Totally 129 patients(129 eyes)completed the follow-up of 1a, including 64 patients(64 eyes)from the CAT group and 65 patients(65 eyes)from the LCAT group. Four patients(4 eyes, recurrence rate 6.2%)in the CAT group and 3 patients(3 eyes, recurrence rate 4.6%)in the LCAT group developed recurrence. However, there was no significant in recurrence rate between CAT group and LCAT group(<i>P</i>=0.718). There were significant differences between before surgery and after surgery in each group(<i>P</i><0.05), and there were significant differences between 1mo after surgery and 3, 6mo and 1a after surgery in each group(<i>P</i><0.05), while there was no significant different among 3, 6mo and 1a after surgery in each group in TBUT, SⅠt and OSDI(<i>P</i>>0.05). Also there was no significant different between CAT group and LACT group in each time in TBUT, SⅠt and OSDI(<i>P</i>>0.05).<p>CONCLUSION:Both CAT and LCAT could effectively treat primary pterygium with low and similar recurrence rate, and the degree of improvement of tear film after primary pterygium operation is similar between the two surgical methods.
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@#AIM: To observe the clinical efficacy of limbal-conjunctival autograft transplant(LCAT)for double-head pterygium.<p>METHODS: Prospective case study. Totally 46 patients(54 eyes)diagnosed with double-head pterygium collected in PLA 474 Hospital from January 2014 to July 2015, including 8 patients(16 eyes)with binocular double-head pterygium, 11 patients(11 eyes)with monocular double-head pterygium and the other eye with nasal side pterygium, pterygiun eyes only included as study subject, and 27 patients(27 eyes)with monocular double-head pterygium. The eyes with double-head pterygium underwent pterygium resection and autologous corneal limbal stem cell transplantation, nasal conjunctival flap was gotten from the superior bulbar conjunctiva of affected eye, and temporal conjunctival flap was gotten from the inferior bulbar conjunctiva of other eye. Follow-up the patients on 1d, 7d, 1mo and 1a after operation to complete the vision and slit lamps to observe the complications and pterygium recurrence.<p>RESULTS: Forty-four patients(52 eyes)completed the follow-up of 1a, while 2 patients(2 eyes)were lost. Three patients(3 eyes)developed recurrence, and the recurrence rate was 6%. Two eyes with nasal side pterygium developed recurrence and 1 eye with temporal side pterygium developed recurrence, while there was no complication observed.<p>CONCLUSION: Nasal conjunctival flap was gotten from the superior bulbar conjunctiva of affected eye, and temporal conjunctival flap was gotten from the inferior bulbar conjunctiva of other eye for double-head pterygium had good clinical effect and low recurrence rate, which provide a better way to treat double-head pterygium.
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·AIM:To observe the clinical effect of limbal conjunctival autograft transplantation (LCAT) or amniotic membrane transplantation ( AMT ) in treatment of primary pterygium. ·METHODS:Analysis of 96 cases(96 eyes) with primary pterygium treated at Shenzhen People's Hospital from January 2013 to December 2015 was taken. Depending on the surgical methods, the patients were divided into two groups: excision of pterygium and limbal conjunctival autograft transplantation being performed in LCAT group (46 cases,46 eyes); excision of pterygium and amniotic membrane transplantation being performed in AMT group (50 cases, 50 eyes). Two groups were followed-up for 12mo to compare the operation time, the corneal epithelium repair time, postoperative complications and the recurrence rate. ·RESULTS:The operation time of LCAT and AMT group was 33. 83 ± 1. 65min, 23. 60 ± 1. 51min respectively, the LCAT group was higher than the AMT group (t=-31.683, P<0.001). The corneal epithelium repair time of LCAT and AMT group was 4.04±0.95d,4.67±1.18d respectively, the LCAT group was lower than the AMT group (t=-2.922,P=0.004); 1 case was recurred in LCAT group, 3 cases were recurred in AMT group. The recurrence rate was 2% in LCAT group and 6% in AMT group, but it hadn't show a significant statistical difference between the two groups (P = 0. 618). One case of conjunctival granuloma was observed in 2wk after surgery of LCAT group, but no serious complications were observed in AMT group. · CONCLUSION: Limbal conjunctival autograft transplantation and amniotic membrane transplantation are effective and safe methods to primary pterygium, which have advantages of rapid recovery, fewer complications and the lower recurrence rate.
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AIM: To compare the safety and efficacy of conjunctival autograft transplant ( CAT ) and limbal - conjunctival autograft transplant (LCAT) for primary pterygium. METHODS: In this prospective, randomized and controlled clinical study, 120 patients ( 120 eyes ) diagnosed with primary pterygium were collected in NO. 474 Hospital of Chinese PLA from January 2014 to January 2015. The 120 patients enrolled in the study in turn, and divided into two group by the odd and even number. The odd number underwent CAT and the even number underwent LCAT. RESULTS:One hundred and seven patients (107 eyes) completed the follow-up of 1a, including 54 patients (54 eyes) from the CAT group and 53 patients (53 eyes) from the LCAT group. Four patients (4 eyes, recurrence rate 7. 4%) in the CAT group and 2 patients ( 2 eyes, recurrence rate 3. 8%) in the LCAT group developed recurrence. However, there were no significant in recurrence rate between CAT group and LCAT group (P =0. 678). CONCLUSION: CAT and LCAT might be both effective treatment for primary pterygium for reducing the recurrence rate of pterygium. However, LCAT is the optimal surgical method for primary pterygium.
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Objetivo: Evaluar la efectividad y los síntomas en el postoperatorio de la resección de pterigion nasal primario con autoinjerto limbo-conjuntival sin suturas. Diseño del estudio: Estudio prospectivo e intervencional. Métodos: Se incluyeron 58 ojos de 58 pacientes con pterigion nasal primario que fueron llevados a resección con autoinjerto limbo-conjuntival; la fi jación del autoinjerto se realizó con cauterio en 29 pacientes y con sutura en 29 pacientes. Se realizó un seguimiento periódico de los casos por 24 meses y variables como el tiempo quirúrgico, el discomfort en el postoperatorio, el edema de la plastia, la inflamación ocular y las complicaciones fueron evaluadas y comparadas entre los subgrupos. Resultados: El tiempo quirúrgico promedio fue de 16 minutos para el grupo de fijación con cauterio y de 40 minutos en el grupo de fijación con suturas. El discomfort postoperatorio durante los primeros 15 días fue menor en el grupo de fijación con cauterio (p<0.001). No hubo diferencias entre los subgrupos en la tasa de recurrencia, pero el grupo de fijación con cauterio presentó una tasa mayor de dehiscencia de los bordes de la plastia (p<0.001) y del descenso conjuntival (p<0.001). Conclusiones: La resección del pterigion nasal primario con autoinjerto limbo-conjuntival fijado con cauterio es una técnica prometedora que lleva a un menor discomfort postoperatorio que la técnica convencional con suturas, tiene una baja tasa de recurrencias y requiere de un menor tiempo quirúrgico.
Objective: To evaluate the eff ectiveness and postoperative symptomatology of sutureless limbal-conjunctival autograft for pterygium surgery. Study design: Prospective and interventional study. Methods: 58 eyes of 58 patients with primary nasal pterygium that underwent pterygium resection with limbal-conjunctival autograft were included. Graft fi xation was done with cautery in 29 patients and with sutures in 29 patients. The patients were followed with periodic evaluations during 24 months. Surgical time, postoperative discomfort, graft edema, ocular inflammation, and complications were evaluated and compared between groups. Results: The average surgical time was 16 minutes for the cautery group and 40 minutes for the suture group. Postoperative discomfort during the first 15 days was statistically significant lesser for the cautery group (p<0.001). There was no difference in recurrence rate among groups; however, the cautery-fi xation group presented a significantly greater incidence of graft´s edges dehiscence (p<0.001), and superior conjunctiva dehiscence (p<0.001). Conclusions: Primary nasal pterygium resection with cautery-fi xated limbal-conjunctival autograft is a promising technique that causes less postoperative discomfort than conventional sutures, has a low recurrence rate and requires less surgical time.
Subject(s)
Pterygium , Conjunctiva , Eye Diseases , Ophthalmologic Surgical ProceduresABSTRACT
A prospective interventional self-control study to analyse the profile and outcome of suture less and glue free limbal conjunctival autograft for the management of primary pterygium was carried out in 80 eyes with primary nasal pterygium requiring surgical excision. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the eyes followed by bandaging for 24 hours. The patients were followed up post operatively after 24 hrs., on 3rd day, after 1, 3, 6 weeks and at 3 months. They were examined for visual acuity, hemorrhage, wound gape, graft retraction, graft edema, recurrence or any other complication among the study population. The mean age of the patients was 40.78 years (range 19-80), 56.25% of which were females. Graft retraction occurred in 3 eyes (3.75%) and recurrence was seen in 1 eye (1.25%). Hemorrhage was seen in 26 (32.5%) eyes at 24 hours, which persisted in only 06(7.5%) eyes at 3 weeks and resolved completely in 100% of eyes at 6 weeks. Edema was also noted in 4 (5%) eyes, persisted only in 1(1.25%) eye at 3rd day and resolved completely by 1 week. At 6 weeks postoperatively, three (3.75%) eyes showed gain in best corrected visual acuity by one line and one (1.25%) eye by three lines on snellen's drum. No other complication was noted. Suture less and glue free limbal conjunctival autografting following pterygium excision is an effective and safe option for the management of primary pterygium.
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PURPOSE: To evaluate the success and complication rates of triple procedure, including pterygium excision, marginal amniotic membrane insertion beneath the conjunctiva, and limbal-conjunctival autograft in pterygium surgery. METHODS: We conducted a retrospective study on 45 eyes of 45 patients who underwent pterygium surgery between August 2011 and October 2012. After pterygium excision, amniotic membrane was placed beneath the conjunctiva along the margin of the exposed sclera followed by a limbal conjunctival autograft. Success rates, intraoperative and postoperative complications were evaluated. RESULTS: Forty-three eyes with primary pterygium and 2 eyes with recurrent pterygium were enrolled in the present study. The mean age of the patients was 59.87 +/- 14.30 years with a mean follow-up of 12.9 +/- 4.6 months. There were no complications during surgery. Early postoperative complications included partial wound dehiscence in 1 eye and a simple conjunctival cyst on the autografted conjunctiva in the another eye. No clinically significant recurrence (G2, G3) was noted during the observational periods. Thirty-nine (86.7%) and 6 (13.3%) eyes were graded as G0 and G1, respectively. CONCLUSIONS: Our surgical technique not only has the benefits of the limbal conjunctival autograft acting as a barrier against fibrovascular invasion of the cornea and supplying stem cells to the corneal epithelium but also has antiangiogenic effects of amniotic membrane with minimal use. In addition, this technique is a safe surgical method in primary and recurrent pterygium.
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Humans , Amnion , Autografts , Conjunctiva , Cornea , Epithelium, Corneal , Follow-Up Studies , Postoperative Complications , Pterygium , Recurrence , Retrospective Studies , Sclera , Stem Cells , Wounds and InjuriesABSTRACT
Pterygium is a fibro vascular encroachment of the conjunctival tissue on to the cornea, causing variable degree of ocular morbidity. Various surgical modalities have been developing to decrease the recurrence. The idea of study is to compare the relative efficacy of two well known procedures i.e. conjunctival autografting and intra-operative Mitomycin –C (0.02%) with reference to recurrence and complication rate.
Subject(s)
Pterygium/surgery , MitomycinABSTRACT
PURPOSE: To evaluate the effectiveness of Mitomycin C used as a combined therapy along with limbal-conjunctival autograft for primary pterygium. METHODS: Thirty eyes of 29 patients received Mitomycin C (0.02% MMC 3 minutes) with limbal-conjunctival autograft, and 30 eyes of 28 patients received limbal-conjunctival autograft alone. Recurrence and complications were evaluated in the patients at 2 weeks, 1, 3, 6 and 12 months postoperatively. RESULTS: Mean follow-up periods were 13.4+/-2.1 and 13.9+/-2.9 months, respectively. Between the two groups, recurrence in the conjunctiva or the cornea was not observed during the follow-up period. In the Mitomycin C use group, complications included a granuloma at the donor site (1 eye, 3.3%), wound dehiscence (2 eyes, 6.7%), and subgraft hemorrhage (2 eyes, 6.7%). In comparison, in the group treated with limbal-conjunctival autograft alone, complications included granuloma at the donor site (1 eye, 3.3%), pseudopterygium at the donor site (1 eye, 3.3%), wound dehiscence (3 eyes, 10%), and subgraft hemorrhage (2 eyes, 6.7%). CONCLUSIONS: The use of Mitomycin C as an adjuvant therapy has no significant effect on the recurrence rate in primary pterygium with limbal-conjunctival autograft.
Subject(s)
Humans , Conjunctiva , Cornea , Eye , Follow-Up Studies , Granuloma , Hemorrhage , Mitomycin , Pterygium , Recurrence , Tissue DonorsABSTRACT
·AIM: To investigate the efficiency of limbal conjunctival autografting technique in patients with primary pterygium.·METHODS: Fifteen eyes of 15 patients with primary pterygium underwent surgery for the removal of pterygium with limbal conjunctival autograft. After the pterygium excision, the limbal portion of the graft was oriented and sutured to the limbus at the recipient bed with the epithelial surface upside. Recurrence was defined as fibrovascular tissue of more than 1 mm over the cornea in the area of previous pterygium excision.·RESULTS: With mean follow-up period of 8 months, neither recurrences nor serious complications were recorded among our patients.·CONCLUSION; Simple excision followed by limbal-conjunctival autograft transplantation is a safe and very effective way of treating primary pterygium.
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PURPOSE: To evaluate the clinical efficacy of amniotic membrane transplantation and limbal-conjunctival autograft for patients with recurrent pterygium or pseudopterygium, the results of 15 eyes of 14 patients were analyzed. METHODS: Total 10 cases of recurrent pterygium and 5 cases of pseudopterygium were surgically managed during June 1998 to July 2000. After excision of pterygium, amniotic membrane was attached on the bare sclera and limbal-conjunctival autograft was transplanted over the amniotic membrane. Mean follow-up period was 47.2 week and all patients were examined for recurrence, which was graded from G0(no vessel) to G3(fibrotic tissue invading the limbus). RESULTS: 12 out of 15 cases(rate 80%) showed no recurrence(grade 0). 1 case of grade 2 recurrence and 2 cases of grade 3(total 3 cases) were observed(rate 20%). Reoperation was performed on 2 cases of grade 3 recurrence. There was no further recurrence necessitating additional reoperation. 1 case of limbal graft was detached and removed. The operation time of this more prolonged than the other procedures, but there were no significant complications. CONCLUSION: Amniotic membrane and limbal-conjunctival autograft for patients with recurrent pterygium or pseudopterygium reconstructed complete ocular surface with less recurrence. Therefore, we recommend this surgical approach as a safe and effective method for the treatment of complicated cases of pterygium.
Subject(s)
Humans , Amnion , Autografts , Follow-Up Studies , Pterygium , Recurrence , Reoperation , Sclera , TransplantsABSTRACT
The recurrence is common problem to treat pterygium. Many surgical procedures were adopted to reduce the recurrence rate. We evaluated the surgical results of limbal conjunctival autograft transplantation (LCAT) accompanying application of 0.02% mitomycin C intraoperatively in 10 patients (10 eyes) who had a recurrent pterygium. There were 7 eyes with first recurrence and 3eyes with second recurrence. Mean age of the patients was 57.4 years, and mean follow-up period was 9.3 months. After a pterygium was excised, a sponge soaked in a solution of mitomycin C 0.02% was applied to the sclera at the site of the surgical bed for 2 minutes, then superior temporal limbal tissue was taken with conjunctival flap and transplanted to the excised area. None of all cases recurred for follow-up period and donor conjunctival site was well reepithelialized. In concluion, LCAT accompanying application of 0.02% mitomycin C intraoperatively was effective and safe method for recurrent pterygium.
Subject(s)
Humans , Autografts , Follow-Up Studies , Mitomycin , Porifera , Pterygium , Recurrence , Sclera , Tissue DonorsABSTRACT
Pterygium is a common surgical ocular disease which recurs frequently. Various different techniques have been developed for the successful surgical treatment of pterygium and among them, autograft transplantation is known as the best successful surgical method. For the prevention of recurrence, the corneal epithelium must heal before the fibrovascular tissue grows and reaches to limbus. For this, we have believed that limbal transplanta- tion is more suitable than conjunctival transplantation. We had performed limbal-conjunctival autograft trasplata- tion for 52 patients with primary pterygia whose age was under 40 years old,or whose pterygia had involved above 5mm beyond limbus and had shown diffuse subconjunctival fibrovascular tissue. The recurrence rate was 1.9%and therewere no complications and no surgical problems. Therefore,we recommend this surgical technique as a safe and effective method of treating primary pterygia with the risk factors of recurrence.