Conjunctival autograft surgery ideal option for cases of recurrent pterygium
USA: For the treatment of recurrent pterygium, conjunctival autograft (CAU) results in less repeat recurrence compared to amniotic membrane grafting (AMG), a recent study has suggested.
The study, published in the Canadian Journal of Ophthalmology, further found that the intraoperative use of mitomycin-C (MMC) decreased the recurrence rate but was not statistically significant and was associated with complications.
Conjunctival autograft and amniotic membrane grafting with mitomycin-C are touted to be the most effective for treating primary pterygium, but the optimal surgical treatment of recurrent pterygium is not well established. Hyunjoo Jean Lee, Department of Ophthalmology, Boston University School of Medicine, Boston, Mass, and colleagues therefore aimed to investigate recurrence rates after recurrent pterygium excision surgery performed with CAU or AMG with or without MMC.
For this purpose, the researchers performed a retrospective review of adult patients who underwent recurrent pterygium excision surgery at Boston Medical Center between January 1999 and July 2019. Comparison of postoperative recurrence rates was done between surgical treatment groups: CAU + MMC, CAU, AMG + MMC, and AMG. Postoperative and any intraoperative complications were recorded.
The following were the key findings of the study:
- 41 eyes of 38 patients were identified who underwent recurrent pterygium excision surgery that met inclusion criteria.
- The observed postoperative recurrence rates were 0% (0 of 8 eyes) with CAU + MMC, 17.7% (3 of 17 eyes) with CAU, 45.5% (5 of 11 eyes) with AMG + MMC, and 80.0% (4 of 5 eyes) with AMG.
- The postoperative recurrence rate was significantly lower with CAU than with AMG, both with and without adjuvant MMC.
- There were no statistically significant differences in repeat recurrence rates with or without MMC with CAU or with AMG.
- There was 1 reported case of possible complication from MMC resulting in complete amniotic membrane melt.
"Our findings suggests that in the treatment of recurrent pterygium, CAU results in less repeat recurrence than AMG," the authors wrote.
"Intraoperative MMC use may decrease the recurrence rate, but it is not statistically significant and may be associated with complications," they concluded.
Reference:
Kim YJ, Rao R, Lee HJ. Comparison of surgical techniques for recurrent pterygium. Can J Ophthalmol. 2022 Jun 22:S0008-4182(22)00175-2. doi: 10.1016/j.jcjo.2022.05.011. Epub ahead of print. PMID: 35750200.
