Surgical Preferences in the Management of Primary Pterygium among Anterior Segment Specialists

Purpose: The purpose of this study is to reflect anterior segment specialists’ current practice pattern regarding the management of primary pterygium. Methods: A 24-item survey regarding indications for surgery, different surgical techniques, use of adjuvant pharmacological therapy, type of intraoperative and postoperative pharmacological therapy, and the preferred treatment of early recurrences was sent to members of the Saudi Ophthalmological Society (SOS) and practicing cornea experts including consultants, specialists, and fellows in Saudi Arabia. Results: A total of 61 cornea specialists completed the questionnaire (response rate 49%). More than 95% considered the proximity of the pterygium to the visual axis an indication for excision. The most frequent technique for pterygium excision was extensive head and conjunctival resection, including the base (69%) and intermediate resection of the Tenon's capsule (53%). For conjunctival replacement, conjunctival autograft was preferred by 79%, amniotic membrane (54%), and simple conjunctival closure (46%). Interrupted vicryl sutures, fibrin glue, and combined sutures and tissue adhesive were the preferred graft fixation conveyed by 85%, 46%, and 34% of our experts, respectively. An estimated recurrence rate of 1-5% was stated by 29% of respondents and 46% reported recurrence within 6 to 12 months. Half of the respondents specified using mitomycin C intraoperatively to prevent early pterygium recurrences. When recurrence occurred, corticosteroid was the agent of choice. Conclusion: This study set out to reflect the practice pattern of anterior segment specialists regarding the management of primary pterygium, and it may serve as an insight for further studies to define the optimal management of pterygium.

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.

Dual Pathogenesis of Primary and Recurrent Pterygium: Immunohistochemical Proof

Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust and sun rays are risk factors. The condition is more prevalent in middle-aged males and can be considered as an aging process. The aim of this study is to test both the degenerative and the proliferative components of Pterygium by both reduced glutathione and topoisomerase one activity. Methods: The study applied immunohistochemistry staining for both reduced glutathione and topoisomerase 1. Results: The samples expressed positive glutathione staining in most primary Pterygium conditions and all secondary Pterygium. On the other hand, the topoisomerase 1 immunohistochemistry expressed focal activity in secondary conditions suggesting a progenitor cell role in the pathogenesis of Pterygium in conjunction with oxidative stress. Conclusion: Pterygium represents dual pathology with a proliferative component and a degenerative one that needs further studies. It is possible to use combination immunohistochemistry markers to predict the prognosis of Pterygium behavior.

Tear Film Stability After Primary Pterygium Excision Combined with Limbal Stem Cell Transplantation is Superior to Amniotic Membrane Transplantation: A Meta-Analysis

Purpose To evaluate the tear film stability after primary pterygium excision combined with Limbal stem cell transplantation (LSCT) or amniotic membrane transplantation (AMT). Methods We searched the PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang and VIP databases for all studies on tear film stability after primary pterygium excision combined with LSCT or AMT. The mean difference (MD) and 95% confidence interval (CI) were calculated for outcomes using the fixed effect or random effect model.Results Seven studies with a total of 531 eyes were enrolled in our meta-analysis, which revealed that comparison between the LSCT group and the AMT group: Ocular Surface Disease Index (OSDI) 3 months postoperatively (MD=-5.16, 95%CI:-6.48,-3.85, P＜0.05), Tear break-up time (BUT) 1 or 3 months postoperatively (1 month: MD=0.30, 95%CI:-0.66,1.26, P=0.54; 3 months: MD=1.30, 95%CI:-0.13,2.72, P=0.07), Schirmer I test 1 or 3 months postoperatively (1 month: MD=0.05, 95%CI:-0.41,0.51, P=0.82; 3 months: MD=1.41, 95%CI:0.81,2.02, P＜0.05), Corneal fluorescein staining (CFS) score 1 month postoperatively (MD=-0.49, 95%CI:-1.29,0.31, P=0.23).Conclusion Primary pterygium excision combined with LSCT is associated with better tear film stability changes than AMT.

A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients

Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value &gt; 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue &gt; 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.