Publication: Does Choice of Different Surgical Intervention Play a Role in the Recurrence of Pterygium?
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
There are a wide range of pterygium excision techniques in practice. However,
choosing the best possible option is an important factor to prevent its recurrence.
Objective
To compare the recurrence rate of different excision techniques and understand if a
surgeon can alter the recurrence rate.
Method
A retrospective data of pterygium surgeries operated by a surgeon at Sagarmatha
Choudhary Eye Hospital, Nepal from the year 2016 to 2018 was investigated for
recurrence. The recurrence was measured by an independent Optometrist with
the help of clinical photo and slit-lamp examination. A telephonic directory was
maintained for every patient’s follow up reminder.
Result
Altogether 916 individuals with mean age 56.20 years had undergone pterygium
excision. Bare Sclera 280 (30.56%), Pterygium Extended Conjunctival Transplantation
(PERFECT) 305 (33.29%), Conjunctival auto graft (CAG) 262 (28.60%), Simple
Pterygium excision 60 (6.55%) and Amniotic Membrane Graft (AMG) 9 (0.98%),
jointly formed the total study sample and surgical techniques. Recurrence for Bare
sclera was 172 (61.42%), simple pterygium excision 34 (56.66%), Pterygium extended
conjunctival transplantation 0 (0%), and conjunctival auto graft 2 (0.76%). Compared
conjunctival auto graft with pterygium extended conjunctival transplantation and
simple pterygium with bare sclera revealed similar recurrence rate comparatively.
The p-value obtained were p = 0.2148 and p = 0.8152 (p > 0.05, 95% CI) respectively.
Conclusion
The loss of limbal stem cells in Bare sclera technique acts as stimulant for pterygium
recurrence, in addition the remains of pterygial matter in simple pterygium excision
acts as precursor for recurrence. Pterygium extended conjunctival transplantation
indeed acts as barrier but needs fine surgical skills to perform. Conjunctival auto
graft can be opted as an alternative technique for minimal recurrence as compared
to Pterygium extended conjunctival transplantation.
KEY WORDS
Bare sclera, Conjunctival auto graft, Pterygium surgery, Recurrence
Description
Yadav R,1 Das SS,1 Gupta S,1 Agrawal N2
1Sagarmatha Choudhary Eye Hospital
Lahan, Nepal
2Taparia Eye Hospital
Biratnagar, Nepal
Keywords
Bare sclera, Conjunctival auto graft, Pterygium surgery, Recurrence