A Comparative Study of Topical Mitomycin C, Cyclosporine, and Bevacizumab after Primary Pterygium Surgery

PURPOSE: To compare the recurrence rates and complications associated with instillation of topical mitomycin C, cyclosporine, and bevacizumab after primary pterygium surgery. METHODS: Between July 2013 and June 2014, we performed surgery using the bare sclera method on 132 eyes (132 patients) with primary pterygium. We randomly selected 33 eyes (33 patients) and treated them with artificial tears four times a day for three months, 29 eyes (29 patients) were treated with topical 0.02% mitomycin C four times a day for five days, 34 eyes (34 patients) were treated with topical 0.05% cyclosporine four times a day for three months, and 36 eyes (36 patients) were treated with topical 2.5% bevacizumab four times a day for three months after surgery. We prospectively determined the recurrence rates of pterygium and complications at the six-month follow-up examination. RESULTS: At six months after surgery, the recurrence rates in each group were as follows: 45.5% (15 eyes) in the control group, 10.3% (three eyes) in the mitomycin C group, 20.6% (seven eyes) in the cyclosporine group, and 41.7% (15 eyes) in the bevacizumab group (p = 0.004). No serious complications, except subconjunctival hemorrhages, were observed in any group. CONCLUSIONS: Groups receiving topical 0.02% mitomycin C and 0.05% cyclosporine after surgery showed lower recurrence rates than the control group; however, no difference in recurrence rate was observed between the control group and the group receiving topical 2.5% bevacizumab after surgery.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

PURPOSE: To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium. METHODS: Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively. RESULTS: With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups. CONCLUSIONS: Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

PURPOSE: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia. METHODS: Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group. CONCLUSIONS: Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.

Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

PURPOSE: To compare the efficacy and safety of fibrin glue and sutures for amniotic membrane transplantation after wide excision of primary pterygium. METHODS: Forty-three eyes of 37 patients underwent amniotic membrane transplantation for primary pterygium with a minimum follow-up period of six months. Twenty-three eyes of 18 patients underwent surgery with fibrin glue and 20 eyes of 19 patients underwent surgery with sutures. Recurrence rates, complications, operating time were evaluated. RESULTS: With a minimum of six-month of follow-up, fibrovascular tissue in the excised area, not invading the cornea (conjunctival recurrence), was noted in four eyes (17.4%) and fibrovascular tissue invading the cornea (corneal recurrence) was noted in two eyes (8.7%) in the fibrin glue group. Conjunctival recurrence was noted in five eyes (25%) and corneal recurrence was noted in one eye (5%) in the suture group. There was no significant difference in the recurrence rates between the two groups. Mean operating time in the fibrin glue group (25.2+/-3.5 minutes) was significantly shorter than in the suture group (40.5+/-3.6 minutes) (p=0.001, Students t-test). Complications included sub-amniotic membrane hemorrhage in three eyes (13%), and granuloma in one eye (4.3%) in the fibrin glue group, sub-amniotic membrane hemorrhage in four eyes (20%), granuloma in three eyes (15%), and wound dehiscence in one eye (5%) in the suture group. CONCLUSIONS: Using fibrin glue instead of sutures in amniotic membrane transplantation after wide excision of pterygium can be considered an effective treatment with shorter operating time and fewer complications, although there is no significant difference in recurrence rates.