Outcome of Inferonasal Conjunctival Autograft in Pterygium Surgery

This study was done to evaluate the outcome of pterygium excision with inferonasal conjunctival autograft at a tertiary eye care centre. Retrospective analysis of medical records of primary pterygia patients operated by a single surgeon between 2017 to 2020 were analyzed. A total of 43 patients who met the inclusion criteria were included in the study. The demographic variables, along with size of pterygium and recurrence over a period of six month follow up was noted. The mean age of patients was 46.97 years (29-74 years). The mean size of pterygium was 3.17 mm. Recurrence was seen in 3 eyes over a period of 6 months. Graft edema was observed in 11 patients and graft hemorrhage along with congestion was seen in 8 cases which resolved over a 3 weeks follow up period. Mild conjunctival scarring was seen over donor area in 5 of the eyes. Pterygium excision with inferior conjunctival autograft is an effective alternative technique to superotemporal autograft technique.

Evaluation of Cyclooxygenase-2 and p53 Expression in Pterygium Tissue Following Preoperative Intralesional Ranibizumab Injection

Introduction: Overexpression of vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2), and p53 are the postulated aetiopathogenesis in pterygium. VEGF is responsible for the induction of COX-2 expression, whereas p53 plays an important role in the regulation of VEGF. This study aimed to evaluate the immunohistochemistry of COX-2 and p53 expressions from excised pterygium tissue from patients who received intralesional ranibizumab (anti-VEGF) injection 2 weeks prior to pterygium surgery.Materials and Methods: An interventional comparative study involving patients presenting with primary pterygium was conducted between September 2015 and November 2017. The patients were randomized into either the intervention or control group. Patients in the intervention group were injected with intralesional ranibizumab (0.5 mg/0.05 ml) 2 weeks prior to surgery. Both groups underwent pterygium excision followed by conjunctival autograft. Immunohistochemistry staining was performed to evaluate COX-2 and p53 expressions in the excised pterygium tissue.Results: A total of 50 patients (25 in both the intervention and control groups) were recruited. There were 34 (68%) patients with grade III pterygium and 16 (32%) patients with grade IV pterygium. There was statistically significant difference in reduction of COX-2 expression in the epithelial layer [84.0% (95% CI: 63.9, 95.5)] (p = 0.007) and stromal layer [84.0% (95% CI: 63.9, 95.5)] (p < 0.001) between intervention and control groups. There was no significant difference in the reduction of p53 expression between the two groups.Conclusion: This study demonstrated the possible use of intralesional anti-VEGF treatment prior to pterygium excision as a potential future modality of adjunctive therapy for pterygium surgery.

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.

Scedosporium scleritis following pterygium excision with conjunctival autograft

A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery

Background The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration. Material and Methods This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017. Results The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 – 7) minutes in group 1 and 8.23 ± 1.26 (8 – 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001). Conclusions The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

APPLICATION OF AUTOLOGOUS SERUM EYE DROPS AFTER PTERYGIUM SURGERY

Objective: To compare the corneal epithelium healing time and post-operative pain after pterygium surgery with and without he use of autologous serum drops. Study Design: Comparative cross-sectional study. Place and Duration of Study: Eye Department, Combined Military Hospital Quetta, from Jan to Aug 2019. Methodology: Twenty patients were included in this study and divided into two groups. All patients underwent pterygium excision with conjunctival autograft. Fourteen of them were instilled with autologous serum drops while 14 were given lubricants postoperatively until corneal epithelium healed completely. Corneal epithelium healing time, visual analog scale for postoperative pain assessment, conjunctival inflammation and recurrences were evaluated. Patients were followed up for 6 months. Results: For corneal epithelial healing, 1 (7.14%) patient showed complete healing on day 2 while 7 (50%) showed healing on day 3 and 6 (42.86%) on day 4. While in non-autologous serum drops group 7 (50%) showed complete healing on day 4 while 4 (28.57%) showed healing on day 5 and 3 (21.43%) on day 6. The mean corneal healing time of autologous serum drops group was 3.36 ± 0.63 days and that of non-autologous serum drops group was 4.71 ± 0.83 days. Patients of autologous serum drops group also experienced significantly less pain as compared to the non-autologous serum drops group. While the recurrence rate and conjunctival inflammation in the two groups was found to be of equal degree. Conclusion: Patients who used autologous serum eye drops post operatively experienced less pain and their corneal epithelium healed earlier than the.......

Pterygium surgery using a conjunctival autograft

Surgery is the only effective treatment for pterygium. The most common technique is the use of a conjunctival autograft after excision of the pterygium. However, the frequency of recurrences of this method, as well as possible complications in different sources, are different. Purpose. To evaluate the efficacy, safety and recurrence rate of conjunctival autograft after pterygium excision. Material and methods. 101 patients with pterygium. aged 57.31 ± 14.7 years. The follow-up period was 1 year in 56 patients and 2 years in 45 patients. All patients underwent excision of the pterygium with conjunctival autograft. Results. An intraoperative complication can be attributed to the insufficient area of the autoconjunctival graft during its transfer to the sclera, which occurred in three patients. Postoperative complications: graft edema in 14 cases (13.86%), granuloma in the suture area was observed in 1 case (0.99%). Recurrence of pterygium was noted in only three cases (2.97%). Conclusion. The use of a conjunctival autograft in pterygium surgery has shown its effectiveness and safety, as well as a low recurrence rate. The donor zone in the upper and lateral makes it possible to excise a sufficient area of autoconjunctival graft with preservation of the intact area of possible future surgery for glaucoma. Key words: conjunctival autograft, pterygium, recurrence of pterygium.