Updates on the Treatment of Pterygium

AbstractPterygium is an ocular disease characterised by the growth of fibrovascular conjunctiva on the cornea. It occurs more often in men, at an older age, and in individuals exposed to ultraviolet radiation. Surgical treatment is the primary treatment for pterygium and there are two common procedures for pterygium excision. In the first method, the head of the pterygium is separated from the corneal surface using a surgical blade. The second method is based on avulsion. Other approaches to excising the pterygium include the use of argon laser and excimer laser. Because of a high recurrence rate, adjuvant therapies, including radiotherapy, chemotherapy, and graft procedures, are used after pterygium excision. These procedures have become the standard long-term treatments for pterygium. Radiotherapy is based on beta irradiation. Chemotherapy includes the use of mitomycin C, 5-fluorouracil, bevacizumab, and loteprednol etabonate. Graft procedures include amniotic membrane grafts and conjunctival autografts. Many surgeons believe that using mitomycin C and conjunctival autografts provides the best outcomes in terms of recurrence, cosmetics and patient satisfaction.

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Surgical Treatment of Atrial Fibrillation: A Review

Cardiology Research and Practice ◽

10.4061/2011/214940 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Nadine Hiari

Keyword(s):

Atrial Fibrillation ◽

Surgical Treatment ◽

Conduction Block ◽

Surgical Techniques ◽

Maze Procedure ◽

Energy Sources ◽

High Recurrence Rate ◽

Surgical Ablation ◽

Alternate Energy

Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1) reduce embolic complications, particularly stroke, (2) alleviate symptoms, and (3) prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

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Endoscopic surgical treatment of bilateral coronal craniosynostosis

Neurosurgical Focus: Video ◽

10.3171/2021.1.focvid20136 ◽

2021 ◽

Vol 4 (2) ◽

pp. V13

Author(s):

Yasser Jeelani ◽

Mark R. Proctor

Keyword(s):

Surgical Treatment ◽

Endoscopic Surgery ◽

Multimodal Treatment ◽

Primary Treatment ◽

Consecutive Series ◽

Long Term Outcomes ◽

Treatment Paradigm ◽

Single Suture ◽

Over Time

Endoscopic surgery for single-suture synostosis has been widely adopted since its introduction over 2 decades ago. Its role in syndromic synostosis is emerging, both as a primary treatment and as the first stage in a multimodal treatment paradigm aimed at preventing the vexing turribrachycephaly seen in these children. In this video, the authors review the technique for endoscopic treatment of bilateral coronal craniosynostosis and discuss both the benefits and some of the concerns to look out for over time. They also review the long-term outcomes in a consecutive series of patients treated in this fashion. The video can be found here: https://vimeo.com/516351348.

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Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery

Journal of Ophthalmology ◽

10.1155/2015/891582 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Tommy C. Y. Chan ◽

Raymond L. M. Wong ◽

Emmy Y. M. Li ◽

Hunter K. L. Yuen ◽

Emily F. Y. Yeung ◽

...

Keyword(s):

Mitomycin C ◽

Recurrence Rate ◽

Clinical Assessment ◽

Original Study ◽

Conjunctival Autograft ◽

Significant Difference ◽

Pterygium Surgery ◽

Pterygium Excision ◽

Double Head

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery.Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one “head” (temporal or nasal) and MMC on the other “head.” All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study.Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P=0.020). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (P=0.024).Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery.

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Comparison of Endovascular and Surgical Treatment for Ruptured Cerebral Aneurysms with Respect to Short and Long-Term Outcome

Interventional Neuroradiology ◽

10.1177/159101990401000204 ◽

2004 ◽

Vol 10 (2) ◽

pp. 129-134 ◽

Cited By ~ 1

Author(s):

K. Fukui ◽

O. Suzuki ◽

S. Ito ◽

M. Miyazaki ◽

K. Hattori ◽

...

Keyword(s):

Surgical Treatment ◽

Endovascular Treatment ◽

Posterior Circulation ◽

High Recurrence Rate ◽

Long Term Outcome ◽

Ruptured Aneurysms ◽

First Choice ◽

Posterior Circulation Aneurysms ◽

Short And Long Term

We compared the treatment for ruptured aneurysms from the clinical and radiological follow-ups after endovascular (GDC) or surgical treatment. There were 142 surgically treated cases and 38 endovascular treated cases from May 1997 to December 2001. In endovascular cases there were four A-com, four MCA, 12 ICA and 18 posterior circulation aneurysms. In surgical cases, there were 53 A-com ACA, 51 MCA, 36 ICA and two posterior circulation aneurysms. The clinical outcomes of endovascular and surgical treatments were correlated with the H & H grades before treatments. At short stage, 71% of endovascular and 78.2% of surgical cases showed a favorable outcome (GOS GR or MD) (p = 0.3). Long-term clinical follow ups (14.5 to 58 months) showed 77.7% of endovascular and 87.7% of surgical cases resulted in GR or MD (p = 0.17). In endovascular cases, 22.2% showed recurrence during the follow-up period and five of them needed re-treatment. We experienced failed endovascular approach at acute stage in seven cases which changed to surgery. In conclusion, the short and long term clinical results of endovascular treatment were acceptable comparing surgical clipping. High recurrence rate after GDC treatment did not permit future completeness of the treatment. Still the treatment alternative between endovascular or surgical treatment may change depending on the criteria of each institution, attention should be paid to the disadvantages of endovascular treatment as the first choice for ruptured aneurysms.

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