Comparison of efficacy of three suture methods in pterygium conjunctival transplantation / 中华实验眼科杂志

Objective:To evaluate the efficacy of embedding suture in pterygium excision combined with autologous conjunctival transplantation, and to compare the differences between embedding suture, continuous suture and intermittent suture.Methods:A randomized controlled study was conducted.One hundred and twenty patients (120 eyes) with primary pterygium, who underwent pterygium excision combined with autologous conjunctival transplantation in Shanghai Aier Eye Hospital from May to July 2020, were enrolled.The patients were randomly divided into the embedding suture group, continuous suture group and interrupted suture group, with 40 eyes in each group.The operation duration was recorded and the patients received follow-up visit at 0.5, 1, 3, 7, 10, 14 days and 1, 3 and 6 months after the operation.The five-point method was used to record the postoperative pain score.The corneal epithelial healing was evaluated by sodium fluorescein staining.The complications such as graft detachment, graft displacement or pterygium recurrence were observed with a slit lamp microscope.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Shanghai Aier Eye Hospital (No.SHAIER2020RB03). Written informed consent was obtained from each subject before any medical examination.Results:The operation time of continuous suture, interrupted suture and embedding suture was (14.45±2.78), (16.28±2.24) and (16.58±2.22) minutes, respectively, and the overall difference was statistically significant ( F=8.98, P<0.05). The operation time of continuous suture was significantly shorter than that of interrupted suture and embedding suture (both at P<0.017), and there was no significant difference between embedding suture and interrupted suture ( P>0.017). There was a statistically significant overall difference in pain scores among the three groups at various time points after the operation ( P<0.05). At 0.5, 1, 3, 7 and 10 days after the operation, the pain scores of embedding suture were lower than those of continuous suture and interrupted suture (all at P<0.05). On the 7th day after the operation, there was no significant difference in the unhealed rate of corneal epithelium among the three groups ( P=1.000). On the 10th day after the operation, the corneal epithelia of the three groups were all healed.During the six months after the operation, no complications such as displacement, detachment, necrosis, infection of graft and eye movement disorder occurred in the three groups.There was no significant difference in the recurrence rate of pterygium ( P=1.000). Conclusions:Embedding suture method can effectively reduce the irritation symptoms after pterygium conjunctival transplantation, and has stable fixation of implants.Compared with the traditional interrupted suture, it does not increase the recurrence rate, incidence of adverse reactions, operation time and economic burden of patients.

Tarsoconjunctival flap in scleral necrosis: report of three cases / Retalho tarsoconjuntival em necrose escleral: relato de três casos

ABSTRACT To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the same surgeon. Recovery was satisfactory from both anatomical and functional perspectives in all cases, and the technique was considered effective and safe. Although there are only few reports about this technique in the literature, it can be considered as a good alternative to treat scleral necrosis.

RESUMO O objetivo deste estudo foi relatar uma série de três casos (quatro olhos) de necrose escleral pós-exérese de pterígio, em que se utilizou como tratamento a técnica de retalho tarsoconjuntival. Foram selecionados três pacientes que evoluíram para necrose escleral após tratamento cirúrgico de exérese de pterígio: o primeiro caso após técnica de esclera nua, com evolução para afinamento escleral no pós-operatório imediato; o segundo e o terceiro fizeram uso de betaterapia e apresentaram necrose escleral tardiamente. A técnica de recobrimento tarsoconjuntival foi executada pelo mesmo cirurgião. A recuperação foi satisfatória em todos os casos, do ponto de vista anatômico e funcional, sendo eficiente e segura. Apesar das escassas menções na literatura, essa técnica pode ser considerada uma boa alternativa para tratamento da necrose escleral.

A comparison of two conjunctival rotation autograft techniques in primary pterygium surgery / Comparação de duas técnicas de rotação de auto-enxerto conjuntival na cirurgia de pterígio primário

ABSTRACT Purpose: To compare the effects of 90° and 180° conjunctival rotational autograft (CRA) techniques used in primary pterygium surgery. Methods: Forty-five patients were included in this retrospective study. Visual acuity (VA), corneal topography, and auto-refractometer measurements, as well as detailed biomicroscopic examinations, were performed preoperatively and postoperatively. During surgery, the pterygium tissue was excised then rotated 90° in Group 1 and180° in Group 2, after which it was sutured to the bare sclera. Pterygium recurrence was defined as corneal invasion ≥1 mm. Results: Group 1 consisted of 21 patients with a mean age of 45.1 ± 11.8 years, while Group 2 comprised 24 patients with a mean age of 47.9 ± 13.8 years. The pterygia in Group 1 were graded as more advanced than those in Group 2. A similar number of recurrences were observed in Group 1 (14.3%) and in Group 2 (16.7%). There was no statistically significant difference in terms of the preoperative and postoperative VA and astigmatism values between the two groups. There was a statistically significant improvement in the postoperative VA and astigmatism values in Group 1 and in the postoperative astigmatism values in Group 2. Although postoperative redness was more common in Group 1, no statistically significant difference was found between the groups. Conclusion: BothCRA techniques can be successful in patients for whom it is desirable to avoid a conjunctival autograft and for patients without high cosmetic expectations.

RESUMO Objetivo: Comparar os efeitos das técnicas de auto-enxerto rotacional de conjuntiva (CRA) de 90° e 180°, usadas na cirurgia de pterígio primário. Métodos: Quarenta e cinco pacientes foram incluídos neste estudo retrospectivo. Acuidade visual (AV) pré e pós-operatória, topografia da córnea, auto-refratometria e exames biomicroscópicos detalhados foram feitos. Durante a cirurgia, o tecido de pterígio foi excisado e o mesmo tecido foi girado 90° no Grupo 1 e 180° no Grupo 2, após o que foi suturado à esclera nua. A recorrência do pterígio foi definida como invasão da córnea ≥1 mm. Resultados: O Grupo 1 consistiu em 21 pacientes, cuja média de idade foi de 45,1 ± 11,8 anos e o Grupo 2 compreendeu 24 pacientes, cuja idade média foi de 47,9 ± 13,8 anos. O Grupo 1 teve maior frequência de pterígios classificados como mais avançada do que no Grupo 2. Um número similar de recorrências foi observado no Grupo 1 (14,3%) e no Grupo 2 (16,7%). Não houve diferença estatisticamente significativa em termos de valores pré e pós-operatórios de AV e astigmatismo entre dois grupos. Houve uma melhora estatisticamente significativa nos valores pós-operatórios de AV e astigmatismo no Grupo 1 e nos valores de astigmatismo pós-operatório no Grupo 2. Embora a vermelhidão pós-operatória tenha sido detectada mais comumente no Grupo 1, não foi encontrada diferença estatisticamente significante entre os grupos. Conclusão: Ambas as técnicas de CRA podem ser bem sucedidas em pacientes onde é desejável evitar um auto-enxerto conjuntival livre e para quem a expectativa de cosméticos não é alta.

Avaliação de aplicação única subconjuntival pré-operatória de mitomicina C em pterígio primário / Evaluation of preoperative subconjunctival single application of mitomycin C in primary pterygium

Resumo Pterígios são lesões geralmente benignas que na maioria dos casos não requer tratamento específico. É um crescimento fibrovascular sobre a córnea, geralmente a partir do lado nasal. Sua causa ainda não foi elucidada, mas parece estar relacionada à exposição aos raios ultravioleta. Quando os sintomas não são controlados com tratamento conservador, a cirurgia é indicada, porém o índice de recidiva ainda é alto, e os esforços têm sido no sentido de reduzir esse índice. A mitomicina C (MMC) é uma opção de adjuvante à cirurgia por ser um inibidor da proliferação de fibroblastos, diminuindo o risco de recorrência do pterígio. Relatamos aqui um caso que descreve cirurgia de pterígio realizada em ambos os olhos de uma mesma paciente, sendo um com MMC e outro sem ela. Os resultados e o índice de proliferação celular dos dois olhos foram comparados entre si.

Abstract Pterygia are usually benign lesions that do not require specific treatment. It is a fibrovascular growth onto the nasal side of the cornea. It`s cause has not been fully elucidated yet, but seems to be related to long -term ultraviolet ray exposure. When symptoms are not controlled with conservative treatment surgery is considered, but the recurrence rate is still high, and efforts have been made to avoid it. Mitomycin C (MMC) is a fibroblast proliferation inhibitor that can be used as adjuvant to surgery to reduce recurrence. We report here a case that describes pterygium surgery performed in both eyes of the same patient, being one with MMC and the other eye without it. Both pterygium were sent to laboratory analysis. The results and proliferation index were compared between the eyes.

A comparative study on the inhibitory effects of commonly used clinical drugs on in vitro fibroblasts from recurrent pterygium / 中华实验眼科杂志

Background Pterygium is one of the common ocular surface disorders,and the main drugs for pterygium include dexamethasone (DXM),interferon α-2b (IFN-α2b),mitomycin C (MMC),5-fluorouracil (5-FU),cyclosporin A (CsA) and tacrolimus (FKS06).However,the efficacy of these drugs on the fibroblasts from recurrence pterygium is unelucidated.Objective This study was to compare the efficacy of DXM,IFN-o2b,MMC,5-FU,CsA and FK506 on proliferation and apoptosis of recurrent pterygium-derived fibroblasts in vitro.Methods The specimens of recurrence pterygium were collected during surgery in Tianjin Medical University Ophthalmological Hospital from May 2015 to July 2016 under the written informed consent.Fibroblasts were isolated and cultured by explant culture method and identified by immunochemistry.DXM,IFN-α2b,MMC,5-FU,CsA and FK506 were added into the medium for 48 hours,respectively,and the cells cultured without drug were used as the control group.The inhibitory efficiency of different concentrations of DXM,IFN-α2b,MMC,5-FU,CsA and FK506 on the cell proliferation was assayed by cell counting kit-8 (CCK-8),and 50％ inhibiting concentration (IC50) of the drugs was calculated.The cells were treated by the IC50 dose of drugs for 48 hours,and cell apoptotic proportion and cell cycle were assessed by flow cytometry analysis.The expression of proliferating cell nuclear antigen (PCNA) in the cells after treated by drugs was detected by immunochemistry.Results Cultured cells grew well with the fusiform shape and radial arrangement.Vimentine showed the positive expression and keratin was absently expressed in the cells.The IC50 to the cells was (3.5×103±2.83×10-2)mg/L,(6.1×102±3.6×10-3)mg/L,(3.2×10-1±1×10-4)mg/L,(2.2× 101 ± 1.2× 10-3) mg/L,(6.3 × 101 ±2.5 × 10-3) mg/L and (6.0× 101 ± 0.0× 100) mg/L in the DXM,IFN-α2b,MMC,5-FU,CsA and FK506,respectively.In the 48 hours after treated by the IC50 drugs,the apoptotic ratio was (35.00± 3.21)％,(30.37±1.67)％,(26.11±0.75)％,(22.01±0.07)％,(20.95±1.68)％ and (19.85±0.52)％ in the IFN-α2b group,CsA group,MMC group,FK506 group,DXM group and 5-FU group,which was significantly higher than (11.38±2.18) ％ in the control group (all at P＜0.05).The cell proportion of G0/G1 phase,S phase and G2/M phase was (85.64±2.62)％,(5.29±1.56)％ and (2.73-±2.66)％ in the control group,and the cell proportion of G0/G1 phase was reduced,while that of S phase or G2/M phase was considerably increased in various drug groups (all at P＜0.05),with the blocking efficiency of cell cycle was in turn MMC,CsA,5-FU,DXM,IFN-α2b and FK506.The expressional rate of PCNA in the cells was (95.00 ± 2.00) ％,(82.67 ± 5.04) ％,(80.00 ± 2.78) ％,(64.00± 6.55)％,(38.00±3.00)％,(32.00±4.36)％ and (29.67±3.02)％ in the control group,FK506 group,DXM group,5-FU group,IFN-α2b group,CsA group and MMC group,showing a significant difference among the groups (F=25.995,P＜0.01),and the expressional rate of PCNA was significant lower in various drug groups than that in the control group (all at P＜0.05).Conclusions DXM,IFN-α2b,MMC,5-FU,CsA and FK506 are all able to inhibit the proliferation and promote the apoptosis of recurrent pterygium-derived fibroblasts in vitro,and MMC and CsA appear to have a stronger effect.

Management of necrotizing scleritis after pterygium surgery with rituximab / Tratamento com rituximabe de esclerite necrosante após cirurgia de pterigeo

ABSTRACT The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.

RESUMO Os autores apresentam um caso de sucesso no tratamento com rituximabe de esclerite necrosante após cirurgia de pterígio refratário a altas doses de corticosteroides e drogas imunossupressoras. Uma revisão da literatura direcionada ao uso de rituximabe para tratamento de esclerites necrosantes revelou relatos de casos e um estudo clínico randomizando fase I/II. Este é o único caso descrito de rituximabe para o tratamento de esclerite necrosante pós cirúrgica. O uso de anticorpo anti-CD20 pode ser uma opção em casos refratários aos imunossupressores no tratamento da esclerite necrosante pós-cirúrgica.

Pterígio sob flap de LASIK / Pterygium growing below the LASIK flap region

RESUMO O pterigio é uma lesão fibrovascular da superfície ocular que pode ter um comportamento agressivo e em alguns casos ameaçar a visão. Embora não exista consenso da sua patogênese, evidências recentes sugerem que seja uma condição proliferativa relacionada com a exposição à radiação ultravioleta. Relatamos aqui um caso de pterígio que cresceu sob a região do flap de cirurgia refrativa (LASIK).

ABSTRACT Pterygium is a fibrovascular lesion of the ocular surface that can display an aggressive clinical behavior and, occasionally, threaten vision. Although there is no consensus on its pathogenesis, recent evidence suggests that it is a proliferative, rather than degenerative condition, strongly correlated with exposure to ultraviolet radiation. We report a case of pterygium that grew up bellow the flap Lasik region after the surgery.

Uso de Mitomicina C intraoperatoria en la cirugía de Pterigion para evitar la ocurrencia de recidiva / Use of intraoperative mitomycin-c in pterygium surgery to prevent the pterygium recurrence

Objetivo: Evaluar la ocurrencia de recidivas y otras complicaciones con el uso de Mitomicina C intraoperatoria en la cirugía de pterigio. Diseño del estudio y métodos: Se diseñó un estudio de retrospectivo, comparando la aplicación de Mitomicina C 0,1% intraoperatoria con la realización de injerto en la cirugía de pterigion en la clínica Medyser de Bucaramanga, Colombia. Se estudiaron un total de 305 ojos operados en este centro entre el primero de marzo de 2014 y el 29 de febrero de 2016, distribuidos en dos grupos, 126 ojos en el grupo de expuestos y 179 ojos en el grupo de no expuestos. Resultados: Se encontró que existe un factor protector del uso de Mitomicina C aplicada intraoperatoriamente para disminuir la incidencia de complicaciones como el dellen corneal, presencia de recidivas, leucoma residual, sobreinfección, hemorragia subconjuntival, haze corneal y rasgado por la sutura, con mayor riesgo de presentar granulomas y reabsorción del injerto. Conclusiones: De acuerdo a esto, la utilización de la Mitomicina C se presenta como una alternativa muy segura y eficaz en el manejo quirúrgico del pterigion, usada al 0,1% por 30 segundos, como se propone; sin embargo, se hace necesario diseñar un ensayo clínico comparativo con el gold standard actual como es la realización del injerto libre con células limbares.

Objective: To evaluate the pterygium recurrence and complications by the use of Mitomycin C during surgery. Study Design and Methods: We designed a retrospective study, comparing the application of Mitomycin C 0,1% intraoperative with the use of a graft in pterygium surgery at the Medyser Clinic in Bucaramanga Colombia, we studied 305 eyes operated at this center between the fi rst March 2014 and 29 February 2016 and were distributed into two groups: 126 eyes in the exposed group and 179 eyes in the non-exposed group. Results: We found there is a protective factor in the use of Mitomycin C applied intraoperatively to decrease the incidence of complications as the corneal dellen, pterygium recurrence, residual leucoma, infection added, conjunctival hemorrhage, haze corneal and graft rupture by suture, with greater risk of granulomas presence and graft resorption. Conclusions: Accordingly, the use of Mitomycin C appears as a very safe and effective alternative, using a 0,1% by 30 seconds, as e proposed, in the surgical management of pterygium; however, it is necessary to design a comparative clinical trial with the today's gold standard as it is the realization of free graft with limbal cells surgery.

Sealing the gap between conjunctiva and Tenon's capsule in primary pterygium surgery / Adição do selamento entre conjuntiva e cápsula de Tenon em cirurgia de pterígio primário

Objetive: To assess the results of an alternative surgical approach in the excision of primary pterygium by analyzing the rates of recurrence and of intraoperative and postoperative complications. Methods: Retrospective cross-sectional study based reviewing the clinical records of individuals subjected to surgery for pterygium, with conjunctival autograft transplantation, fibrin glue and intraoperative application of mitomycin C. In addition, sealing was performed by suturing the gap between the conjunctiva and Tenon’s capsule. A total of 36 eyes from 35 individuals were subjected to the assessed techniques. The study variables were complications of surgery and recurrence rates during a minimun follow-up period of 6 months. Results: No recurrence occurred during the follow-up period. One graft (2.8%) exhibited partial retraction, but pterygium did not recur. The intraocular pressure increased in one eye (2.8%) and was controlled by clinical methods. Conclusion: Eyes in which a barrier was established between the conjunctiva and Tenon’s capsule by sealing the gap between them showed an absence of recurrence in the sample studied. However, there is the need of a random prospective study with a control group for a more accurate conclusion on the efficacy of the technique .

Objetivo: Avaliar os resultados de uma abordagem cirúrgica alternativa na excisão de pterígio primário por meio da observação das taxas de recidiva e de complicações intraoperatórias e pós-operatórias Métodos: Estudo retrospectivo e transversal realizado a partir da revisão de prontuários de pacientes submetidos à cirurgia de pterígio com transplante autólogo de conjuntiva, cola de fibrina e aplicação intraoperatória de mitomicina C. Além disso, foi realizado através de sutura, o selamento da lacuna entre a conjuntiva e cápsula de Tenon. No total, 36 olhos de 35 pacientes foram submetidos à técnica. As variáveis do estudo foram complicações da cirurgia e taxas de recidiva durante um período mínimo de 6 meses de seguimento. Resultados: Não foram constatadas recidivas durante o tempo de seguimento. Um enxerto (2,8%) desenvolveu retração parcial, sem posterior recorrência do pterígio, e um olho (2,8%) apresentou aumento da pressão intraocular, que foi controlada clinicamente. Conclusão: A criação de uma barreira entre a conjuntiva e cápsula de Tenon, por meio do selamento da lacuna, mostrou ausência de recidiva na amostra estudada. Necessita-se, no entanto, de um estudo prospectivo randomizado com grupo controle para uma conclusão mais precisa da eficácia da técnica. .

A subconjunctival foreign body confused with uveal prolapse.

There are cases in which the presence of a foreign body (FB) is difficult to diagnose based on history taking or clinical examination. We report a case of subconjunctival FB confused with uveal prolapse. A 68‑year‑old man, who had the history of pterygium excision in his right eye, complained of irritation and congestion in that same eye. He also had the history of growing vegetables in a plastic greenhouse. It seemed to be a suspected uveal mass bulging through a focal scleral thinning site. On the basis of slit‑lamp magnification, the lesion was presumed to be a hard and black keratinized mass embedded under the conjunctiva. Histopathologically, the removed mass was revealed to be a seed of the dicotyledones. Patients who show signs of prolapsed uvea or scleral thinning, possibility of a subconjunctival FB should be considered as differential diagnosis. In addition, a removed unknown FB should be examined histopathologically.

Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature / "Dellen" escleral grave como complicação precoce de excisão de pterígio com fechamento conjuntival simples e revisão da literatura

We describe a patient with acute scleral dellen (SD) after pterygium excision with simple conjunctival closure. In addition, we present a PUBMED review on the medical literature on early SD after pterygium surgery. This case describes a 45-year-old man who presented with severe SD, 7 days after pterygium surgery with minimal cauterization of episcleral vessels and simple conjunctival closure. No other adjunctive therapy was used intraoperatively. The patient refused conjunctival flap coverage of the lesion. Therefore, medical treatment consisted of antibiotic ointment, patching, and daily follow-up. After 7 days, the patching was changed for intensive ocular lubrication. Five weeks later, the surrounding conjunctiva had completely covered the affected sclera. To the best of our knowledge, this is the first report of early SD following pterygium excision and simple conjunctival closure with no other adjunctive therapy. When performing pterygium excision with conjunctival coverage of the sclera, a close follow-up is recommended to rule out wound dehiscence and SD, even when surgical wound closure is considered to prevent SD. If this complication is detected, the treatment can be conservative.

Descrevemos um paciente com "dellen" escleral agudo (SD) após excisão de pterígio com fechamento conjuntival simples. Uma revisão adicional da literatura médica sobre SD precoce após a cirurgia de pterígio também é realizada. Este caso descreve um homem de 45 anos de idade, que apresentou SD grave, sete dias após a cirurgia de pterígio com cauterização mínima de vasos episclerais e fechamento conjuntival simples. Nenhuma outra terapia adjuvante foi utilizada no intraoperatório. O paciente recusou-se à cobertura de retalho conjuntival da lesão. Portanto, o tratamento médico consistiu em pomada antibiótica, oclusão e acompanhamento diário. Após sete dias, a oclusão foi mudada para a lubrificação ocular intensiva. Cinco semanas após, a conjuntiva cobriu completamente a esclera afetada. Ao melhor de nosso conhecimento, este é o primeiro relato de SD precoce após a excisão do pterígio e fechamento conjuntival simples com nenhuma outra terapia adjuvante. Ao realizar a excisão do pterígio com cobertura conjuntival da esclera, um acompanhamento frequente é recomendado para descartar a deiscência da ferida e SD. Se esta complicação for detectada, o tratamento pode ser conservador.

Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence.

Aims: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. Materials and Methods: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. Results: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P = 0.1806). The recurrence rates were similar in Group B and C (P > 0.05). Conclusions: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow‑up period are needed to supplement this study.

Clinical Characteristics and Treatment of Esotropia Following Bare Sclera Pterygium Surgery

PURPOSE: The clinical features of esotropia after bare scleral pterygium surgery and dipolpia treatment results were evaluated in the present study. METHODS: Twenty eyes of 12 patients who had esotropia after bare sclera pterygium surgery from 2008 to 2011 were retrospectively investigated. RESULTS: Diplopia occurred at 2.8 +/- 1.6 months (1-6 months) after pterygium surgery. The mean pre-operative angle of esotropia was 19.4 +/- 8.9 PD (8-40 PD) at distance and 16 +/- 7.3 PD (0-30 PD) at near. All patients showed limitation of abduction in the pterygium operated eye. Two patients were prescribed prism glasses, 2 patients underwent conjunctiva surgery, and medial rectus recession with simultaneous intraoperative adjustment surgery was performed in 8 patients. An additional strabismus operation was required for 2 patients who received conjunctival surgery due to diplopia recurrence. Seven patients (70%) showed orthotropia at 3 months. CONCLUSIONS: In this study, diplopia following postoperative adhesion caused by bare sclera pterygium surgery technique was observed. Conjunctiva-perimuscular scar tissue removal and medial rectus recession were effective methods in eliminating diplopia.

Short-Term Clinical Outcomes of Pterygium Treatment with Conjunctival Flap Advancement

PURPOSE: The present study reviewed the surgical outcomes of conjunctival flap advancement with pterygial tissue excision in primary and recurrent pterygium. METHODS: In a retrospective survey of 169 eyes of 169 patients who underwent pterygial tissue excision and conjunctival flap advancement surgery, after a three-month follow-up minimum, history of pterygium surgery, surgical outcomes, recurrence rates, and complications were evaluated. RESULTS: The study included 74 male and 95 female patients. The mean age was 56 +/- 11.93 years (range: 31-81 years). One hundred and forty eyes were considered as primary pterygium without history of surgery and 29 eyes were considered as recurrent pterygium. In the cases of primary pterygium, 139 eyes were treated after the surgery without recurrence (success rate: 99.2%) and one recurred case was localized to the sclera. Among the 29 eyes with recurrent pterygium, 26 eyes were treated without recurrence (success rate: 89.7%) and 3 recurred cases were localized to the sclera. There were no significant complications related to the surgical procedures. CONCLUSIONS: Conjunctival flap advancement surgery with pterygial tissue excision was an effective method in primary and recurrent pterygium treatment and showed low recurrence and minimal complications.

Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8- 0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months.RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

Superior-inferior Sliding Conjunctival Flap for Pterygium with a Fibrin Tissue Adhesive (Tisseel(R))

PURPOSE: To report the clinical effect of a superior-inferior sliding conjunctival flap for pterygium using fibrin tissue adhesives (Tisseel(R); Baxter Healthcare Corporation, Glendale, CA) instead of sutures. METHODS: After the primary pterygial tissue was removed from the sclera, a superior-inferior sliding conjunctival flap was created. The fibrin tissue adhesive (Tisseel(R)) was composed of two solution types: fibrinogen containing aprotinin solution and a CaCl solution containing thrombin. The two solutions with 27 G needle were applied on the bare sclera in sequence, and the conjunctival flap was attached into the bare sclera within 5 seconds. We performed this procedure with a fibrin tissue adhesive instead of sutures in three patients, and follow-up for recurrence of pterygium and postoperative complications. RESULTS: The superior-inferior sliding conjunctival flaps were attached into the bare sclera in all patients using fibrin tissue adhesives. We didn't find any significant postoperative complications such as ocular pain, epiphora, foreign body sensation, wound defect, or dehiscence. CONCLUSIONS: A superior-inferior sliding conjunctival flap constructed with fibrin tissue adhesives should be a useful management tool for the inhibition of the recurrence of pterygial.

Mitomycin-C eyedrops for the prevention of postoperative recurrence of pterygium / 眼科

Mitomycin-C eyedrops were administered for the prevention of pterygium recurrence after surgical excision.37 primary and 16 recurrent pterygia were postoperatively instil- led 0.2mg/ml or 0.4mg/ml mitomycin-C eyedrops,and 24 primary and 4 recurrent pterygia were given placebo instead to serve as controls.During a follow-up of 3 to 8 months,one(1.89%)of the 53 eyes treated with mitomycin recurred 3 months after the operation while 3 eyes(10.7%)of the 28 controls recurred,the difference being very significant.The authors opinted that mitomy- cin-C eyedrops of low concentration was safe and effective for the prevention of postop- erative pterygium recurrence.