Conjunctivolimbal autograft using a fibrin adhesive in pterygium surgery

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.     

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft

BACKGROUND AND OBJECTIVES: To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION: We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.     

角膜缘干细胞移植术治疗原发性翼状胬肉

目的：评价自体角膜缘干细胞移植治疗原发性翼状胬肉的安全性和有效性。

方法：前瞻性观察性研究。采用自体角膜缘干细胞移植术治疗鼻侧原发性翼状胬肉264例(男性142例,女性122例)。患者平均年龄54.22±15.24岁。翼状胬肉术后1、3、7d及1、3、6、9、12、36mo进行定期随访。评估手术时间,角膜上皮愈合时间,术后复发率和手术并发症。

结果：平均手术时间为25.7±2.6min。经过至少3a的术后随访,术后角膜上皮愈合时间为3.85±0.72d。14例患者出现眼科并发症。本研究未发现虹膜睫状体炎、睑球粘连、角膜溃疡等威胁视力的严重并发症。结膜移植片水肿5例,肉芽肿形成3例,结膜下血肿6例。随访3a,11例患者复发,复发率为4.17%,首次出现复发时间为3mo,平均8mo。

结论：经长期随访,自体角膜缘干细胞移植术无严重并发症,复发率低,是治疗原发性翼状胬肉安全有效的方法。我们还建议对于原发性翼状胬肉手术,12mo的术后随访为最佳时间。     

Evaluation of the recurrence rate and complications for pterygium treated with limbal conjunctival autograft

AIM: To evaluate the safety and efficacy of limbal conjunctival autograft transplantation for treating primary pterygium over a period of 3y. METHODS: Prospective observational consecutive case series. In this study, 264 eyes of 264 patients (142 males and 122 females) with nasal primary pterygium were treated using the technique of limbal conjunctival autograft. The mean ages of the patients were 54.22±15.24y. After excision of the pterygium patients were followed up on 1, 3, 7d and at 1, 3, 6, 9, 12, and 36mo. Recurrence of pterygium, complications, operation time and corneal epithelialization time were evaluated. RESULTS: The average surgery time was 25.7±2.6min. With a minimum 3-year of follow-up, postoperative corneal epithelialization was completed in 3.85±0.72d. Complications were observed in 14 cases. Vision-threating complications such as iritis, scleral thinning symblepharon or ulceration were not detected in the study. Five eyes with graft edema, 3 eyes with granuloma formation and 6 cases with a subconjunctival hematoma in the nasal conjunctiva. By the end of 3-year follow-up, recurrence was detected in 11 cases. The recurrence rate was 4.17%, and the onset of recurrence was 3mo, the average recurrence time was 8mo. CONCLUSION: There were no severe complications and few recurrences when limbal conjunctival autograft transplantation was performed after long-term follow-up, we suggest that limbal conjunctival autograft transplantation is a safe and effective technique in primary pterygium. We also recommend that 12-month follow-up is optimal on primary pterygium surgery.     

头部撕除法联合羊膜移植治疗翼状胬肉疗效观察

目的:观察头部撕除法联合羊膜移植治疗翼状胬肉的手术效果,评价原发性翼状胬肉最佳手术方法和降低复发率的手术技巧。方法:2008-01/2009-08治疗原发性翼状胬肉20例30眼,手术方法是头部撕除翼状胬肉联合羊膜移植术。观察手术后角膜创面修复时间和术后复发率。结果:术后随访2～18(平均6)mo。治愈28眼,治愈率93%,复发2眼,复发率为7%。角膜创面平均修复时间为2～3d。30眼有22眼术后视力有不同程度的提高。美容效果:患者于裂隙灯显微镜下不易发现翼状胬肉手术痕迹。结论:头部撕除法联合羊膜移植术治疗原发性翼状胬肉恢复快,复发率低,美容效果好。     

乙醇松解翼状胬肉切除联合角膜缘上皮移植的疗效观察

目的 初步观察乙醇松解在角膜缘上皮移植治疗翼状胬肉中的临床效果.方法 随机分组对比研究.将176例(192只眼)初发翼状胬肉随机分A、B两组:A组(87例90只眼)单纯翼状胬肉切除联合角膜缘上皮移植;B组(B组89例102只眼)乙醇松解胬肉切除联合角膜缘上皮移植.对比观察两组角膜创面上皮愈合时间及复发率.结果 A组角膜创面愈合时间平均(5.47±1.33)d;B组平均(3.69±1.38)d,两组差异有统计学意义(t=9.0208;P<0.01).术后随访18～30个月,平均(22.5±5.6)个月,术后6月A、B组均无复发;A组术后6～12月复发3只眼;12～18月复发3只眼;18～24月后复发1只眼,复发率7.87%.B组术后6～18个月无复发,18～24月后复发2只眼,复发率1.96%,差异有统计学意义(U=8.802;P<0.01).结论 乙醇松解胬肉切除联合角膜缘上皮移植从复发基础和原因两方面抑制胬肉复发,值的临床推广应用.     

环孢霉素A在防止翼状胬肉复发中的作用

目的:评价环孢霉素A滴眼剂对防止翼状胬肉复发的作用。方法:将75眼随机分为3组(A,B,C)。A组接受单纯翼状胬肉切除术,B组接受翼状胬肉切除联合自体干细胞移植术,C组接受翼状胬肉切除联合术后应用0.5g/LCSA。对所有眼术前、术后进行检查,评价其复发率,然后进行统计学分析。结果:经过平均6mo随访后,A组有11眼(44%)复发,B组未见复发,C组3眼(12%)复发。经过平均6mo的随访,结果发现组间有显著统计学差异。结论:翼状胬肉单纯切除联合术后局部使用0.5g/L环孢霉素A滴眼剂可以有效防止翼状胬肉的复发。     

5-Fluorouracil as chemoadjuvant for primary pterygium surgery: preliminary report

PURPOSE: To investigate the safety and efficacy of intraoperative application of 5-fluorouracil as an adjuvant in primary pterygium surgery and to evaluate the effect of postoperative subconjunctival 5-fluorouracil injections on the recurrent pterygium. METHODS: Of 25 consecutive white patients, 28 eyes with primary pterygium underwent pterygium excision with intraoperative application of 5-fluorouracil (25 mg/mL for 3 minutes). The superior and inferior conjunctiva was approximated to cover the scleral bed within 1 mm of the limbus. Recurrence of pterygium was defined as postoperative fibrovascular growth more than 1 mm onto the cornea. Eyes with recurrence less than 2 mm were treated with subconjunctival 5-fluorouracil injections. RESULTS: After a mean follow-up of 14.1 +/- 3.9 months (mean +/- standard deviation), 7 recurrences (25%) were observed. All recurrences were detected within 12 months. In 4 of 7 recurrences, the fibrovascular growths were less than 2 mm. We, therefore, performed subconjunctival 5-fluorouracil injections. In 3 (75%) of 4 recurrences, the fibrovascular growths became atrophic. No serious complications were observed during and after the surgery. However, superficial punctate keratitis, pain, and hyperemia were detected in all patients in the early postoperative period. As a result, of 28 eyes, 4 (14%) had unacceptable cosmetic results and growing recurrences. CONCLUSIONS: This study suggests that intraoperative applications of 5-fluorouracil is both efficient and safe in the treatment of primary pterygium. Additionally, postoperative subconjunctival 5-fluorouracil injections may prevent the progression of fibrovascular tissue.     

Pterygium surgery: fibrin glue versus Vicryl sutures for conjunctival closure

PURPOSE: To compare the short-term results of conjunctival closure in pterygium surgery using fibrin adhesive versus Vicryl sutures with respect to operative time, postoperative ocular signs and symptoms, and overall patient satisfaction. METHODS: A comparative prospective randomized clinical trial was performed in 65 patients (65 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative mitomycin C. Patients were randomized to undergo conjunctival closure with a fibrin tissue adhesive (Quixil; n = 39) or 8-0 Vicryl absorbable interrupted sutures (n = 26). Clinical assessment was performed on days 1, 3, 10, and 21 after surgery. Patients completed a questionnaire at each follow-up visit, grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, and overall satisfaction. RESULTS: Average operative time was 16 minutes (range, 14-16 minutes) in the fibrin glue group and 20 minutes (range, 20-29 minutes) in the Vicryl suture group (P < 0.05). Significantly less pain, photophobia, foreign body sensation, irritation, epiphora, itching, local hyperemia, conjunctival chemosis, and dry eye were noted in the subjects treated with glue than in controls (P < 0.05). There were no complications during the 3-week follow-up period in the glue-treated patients. One of the patients in the suture group had a medically treatable corneal delle. CONCLUSION: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort. A longer follow-up is needed to evaluate the influence of fibrin glue on rate of recurrence and long-term complications.     

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.     

自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效。方法:把76例93眼原发性翼状胬肉患者随机分为两组:治疗组(41例51眼)行翼状胬肉切除联合自体角膜缘干细胞移植术;对照组(35例42眼)行翼状胬肉单纯切除术。胬肉复发的定义:血管纤维组织重新侵入角膜。结果:术后随访9～24mo。治疗组治愈率96%,复发率4%;对照组治愈率76%,复发率24%。两组复发率有统计学意义(χ2=8.09,P<0.01),两组均无明显并发症。结论:自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效好,复发率低于单纯切除术。     

Halting pterygium recurrence by postoperative 5-fluorouracil

PURPOSE: To investigate the efficacy of postoperative 5-fluorouracil (5-FU) in halting recurrence of pterygium. METHODS: Early recurrence of pterygium was detected in six eyes of six patients aged 40 to 66 years that, over a 3-year period, had undergone pterygium excision in our institution, using the "bare sclera" technique. Each of the hyperemic fibrovascular tissues was found to override the cornea by 1.5 mm or less in length. Five of these eyes had undergone a primary excision and one, a second operation (with intraoperative mitomycin C). Upon diagnosis, each eye was treated with two to four injections of 5-FU, administered into the dome of the fibrovascular tissue. The dose of 5-FU per injection was 1 to 3 mg (mean, 2.1 +/- 0.8 mg). Of all 126 eyes that underwent pterygium surgery during that 3-year period, pterygium recurred in nine additional eyes but was found to be 2 mm or more in length in each. These eyes were not treated by 5-FU. RESULTS: In five of the six treated eyes, the pterygium became clinically atrophic and the recurrence process was stopped. No renewal of the recurrence process was detected after 12 months or more of follow-up. No major complications were related to the use of 5-FU. CONCLUSION: This pilot study suggests that when early recurrence of pterygium is already evident, 5-FU treatment into the dome of the fibrovascular tissue may be beneficial in halting its progression, by rendering it atrophic. A prospective, randomized, controlled study is required to confirm the efficacy of this approach.     

羊膜移植与结膜移植治疗翼状胬肉的比较

目的:比较翼状胬肉切除联合羊膜移植或游离自体结膜移植对原发性胬肉的治疗效果。方法:对65例74眼行翼状胬肉切除联合羊膜移植术,对61例69眼行翼状胬肉切除联合游离自体结膜移植术,观察两组病例术后疗效。结果:术后随访12～20mo,随访期内,羊膜移植组5例复发,复发率6.7%,结膜移植组8例复发,复发率11.6%。结论:两种方式均能显著降低胬肉术后复发率,但羊膜移植更为理想。     

Limbal-conjunctival autograft transplantation for recurrent pterygium

PURPOSE: To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium. PATIENTS AND METHODS: Seventeen eyes with advanced recurrent pterygium underwent LCAT All had already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised. RESULTS: During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained. CONCLUSIONS: LCAT seems to be a promising and safe procedure for recurrent pterygium.     

Intraoperative mitomycin C in the treatment of pterygium

PURPOSE: To evaluate the effectiveness of intraoperative mitomycin C in preventing the recurrence of primary pterygium. METHODS: In this prospective, randomized study, 38 eyes of 35 patients with primary pterygium were evaluated. In 19 eyes, the "bare sclera technique" combined with intraoperative application of 0.2 mg/mL (0.02%) mitomycin C for five minutes was performed (mitomycin C treated group). The other 19 eyes--taken as control group--underwent surgical excision alone. Statistics were analyzed using the Mann-Whitney U test and the Fischer's exact test. RESULTS: Patients were 20-38 years of age. The mean age was 25.29 +/- 5.08 in the mitomycin C treated group and 25.00 +/- 5.19 in the control group. During the mean follow-up of 17.04 months (range, 12-36 months; SD = 5.89), 4 recurrences (21%) were observed in the mitomycin C treated group and 11 (57.8%) in the control group. The difference between the two groups was significant (p = 0.045). No postoperative complication was encountered in both groups except for recurrences. CONCLUSION: Intraoperative mitomycin C was found to be effective in preventing the recurrence of primary pterygium.     

Fibrin glue versus vicryl sutures for primary conjunctival closure in pterygium surgery: long-term results

PURPOSE: To compare the long-term results of conjunctival closure with fibrin adhesive or Vicryl sutures in pterygium surgery. METHODS: The study was performed in 81 patients (81 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative administration of mitomycin C 0.02%. Patients were randomized to undergo conjunctival closure with a fibrin adhesive (Quixil) (n = 42) or Vicryl sutures (n = 39). Clinical assessment was performed on postoperative days 1, 3, 10, and 21 and thereafter at 3, 6, and 12 months. All patients completed a questionnaire at each follow-up visit grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, overall satisfaction, and recurrence rate. RESULTS: Average operative time was 16 min in the fibrin-glue group and 28 minutes in the Vicryl-suture group (p < 0.05). Significantly less pain and discomfort were noted in the subjects treated with glue than in controls (p < 0.05). Satisfaction was significantly higher in the study group (p < 0.04). There were no complications during follow-up period in the glue-treated patients; one patient in the suture group had a medically treatable corneal dellen. At the end of follow-up, recurrent pterygium developed in five (11.9%) eyes of the fibrin-glue group and in three (7.7%) eyes of the Vicryl-suture group (p < 0.05). CONCLUSIONS: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient pain compared with suturing. However, it may be associated with a higher recurrence rate.     

Pterygium surgery: conjunctival autograft using a fibrin adhesive

PURPOSE: To evaluate the efficiency and safety of using a fibrin adhesive (Tissucol Duo, Baxter AG, Vienna, Austria) to avoid the need for sutures during conjunctival autograft surgery for primary pterygium. METHODS: Twenty patients (20 eyes) with primary nasal pterygium were subjected to conjunctival autograft surgery. The free conjunctival graft placed over the bare sclera was fixed to the surrounding conjunctiva and cornea using the fibrin glue. An occlusive patch was applied. The outcome of surgery and any possible complications were periodically assessed. RESULTS: Mean patient age was 54.9 years (28-75 years). The mean follow-up time was 26.05 +/- 3.15 (SD) weeks. The time of surgery was 15 to 20 minutes. During the postoperative course, none of the patients felt pain, and only 5/20 (25%) had the mild sensation of the presence of a foreign body. In 18/20 (90%) patients, the conjunctival autograft was observed to be correctly positioned and fixed in all the follow-up exams. No sutures were used during or after surgery. There were no cases of regrowth of the pterygium. CONCLUSION: Our findings demonstrate the safety and efficiency of Tissucol Duo as a conjunctival adhesive for pterygium autograft surgery as treatment of primary pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery. Its use also avoids complications derived from sutures and diminishes the sensation of a foreign body in the eye following surgery.     

角膜缘干细胞滑行移植法切除翼状胬肉

目的:比较角膜缘干细胞滑行移植法切除翼状胬肉和传统翼状胬肉逆向切除术对初发性翼状胬肉的疗效。方法:将167例(207眼)初发性翼状胬肉患者随机分成A、B组:A组81例(101眼)行角膜缘干细胞滑行移植法切除;B组86例(106眼)行传统翼状胬肉逆向切除术。以上皮愈合稳定、角膜恢复正常光滑透明、无翼状胬肉样组织生长为治愈,否则视为复发。术后随访24mo,观察比较两组患者术眼不适症状持续时间、角膜上皮愈合时间以及翼状胬肉复发情况。结果:A组3例(3眼)翼状胬肉复发,复发率为3.1%;B组19例(23眼)翼状胬肉复发,复发率为23.5%,两组比较,差异有统计学意义(P<0.01);在术后1,2wk及1mo时,两组不适症状眼数差异有统计学意义(P<0.01);角膜上皮愈合时间比较,差异有统计学意义(P值均<0.01)。结论:角膜缘干细胞滑行移植法切除翼状胬肉具有简便快捷,创伤小,修复快,术后患者自觉症状轻,复发率低等优点。     

Intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery.

PURPOSE: Postoperative recurrence of pterygium occurs in many patients. Intraoperative and postoperative mitomycin therapy are two adjuvant treatment methods shown to lessen the high pterygium recurrence rate seen with simple excision alone. The authors designed a prospective, randomized study to explore the recurrence rate of pterygium after a single dosage of mitomycin C at the completion of pterygium excision, comparing it to postoperative mitomycin C therapy. METHODS: Thirty-six patients with 40 primary and recurrent pterygia were randomized to 1 of 2 treatment groups: intraoperative mitomycin 0.2 mg/ml for 5 minutes (group 1) and postoperative mitomycin 0.2 mg/ml four times a day for 7 days (group 2). The mean follow-up time was 15 months (range, 6 to 24 months). RESULTS: The pterygium recurred in 3 (15%) of 20 eyes in group 1 and in 4 (20%) of 20 eyes in group 2 (p=0.41). One patient in group 1 had a mild scleral melting (1 x 1 mm) and a delay of reepithelialization for three weeks. Moderate superficial punctate keratitis (two eyes) and mild anterior chamber reaction (one eye) developed in group 2. CONCLUSION: This study indicates possible advantages of administration of a single dosage of 0.02% mitomycin C over postoperative mitomycin therapy. If the decision is made to use adjunctive mitomycin, the authors recommend intraoperative over postoperative administration.     

Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery

PURPOSE: To evaluate the long-term postoperative outcome and complication rate of combined intraoperative low-dose mitomycin C application and free conjunctival autograft for the treatment of pterygium. METHODS: In a prospective, consecutive, noncomparative case series, a series of 46 consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The patients' ages ranged from 23.0 to 80.0 years (mean, 53.4 years). All patients underwent pterygium excision combined with intraoperative low-dose mitomycin C application (0.02% for 2 minutes) and free conjunctival autograft. The mean follow-up period was 29.2 months (range 12 to 41 months). The main outcome measures were recurrence of pterygium and postoperative complications. RESULTS: Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. There were no intraoperative complications. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. There were no sight-threatening complications or serious side effects. CONCLUSIONS: By applying a single low dose of mitomycin C combined with free conjunctival autograft during pterygium excision, the recurrence rate of pterygium can be markedly reduced.