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Jessica E. Chan, Jesse J. Jung, Michelle Y. Cho, Daniel Yoon, Abraham Sleem, David Howard; Outcomes of Pterygium Surgery Over 4 Years at an Academic Institution in New York. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4025.
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To report the outcomes of primary and recurrent pterygium surgery over 4 years, and to identify factors associated with recurrence.
A retrospective review of the medical records of 104 patients who underwent pterygium surgery between April 2007 and October 2011 was performed. Factors analyzed included age, gender, right vs. left eye, location of pterygia (nasal vs. temporal), and surgical technique. Techniques included bare sclera (BS), BS with mitomycin C (MMC), sliding conjunctival autograft (SCAG), SCAG with MMC, conjunctival-limbal autograft (CLAG), CLAG with MMC, amniotic membrane transplantation (AMT), and AMT with MMC.
This study included a total of 118 eyes (104 patients), 64 (54.2%) male and 73 (61.9%) older than age 40. Among all eyes, 64 (54.2%) of the pterygia occurred in right eyes, with 99 (83.9%) located nasally and 91 (77.1%) primary. Mean follow-up was 208 days (range 1-1275). Bare sclera technique was performed in 25 (21.2%) of cases, BS/MMC in 36 (30.5%), SCAG in 12 (10.1%), SCAG/MMC in 2 (1.7%), CLAG in 29 (24.6%), CLAG/MMC in 6 (5.0%), AMT in 3 (2.5%), and AMT/MMC in 5 (4.2%). For both males and females, there were more primary than recurrent pterygia (p=0.02). Analysis revealed no statistically significant differences in the number of patients with primary or recurrent pterygia among males vs. females, patients ≤40 vs. patients >40, right vs. left eyes, or nasal vs. temporal locations. Overall, 43 (36.4%) of patients had recurrence after excision. There was no statistically significant difference in failure rates between primary vs. recurrent pterygium excisions (p=0.17). Recurrence rates among primary and recurrent pterygium surgery respectively were as follows: 15 (62.5%) and 1 (100%) after BS, 8 (29.6%) and 2 (22.2%) after BS/MMC, 6 (50%) after SCAG for primary, 1 (50%) after SCAG/MMC for primary, 3 (12.5%) and 2 (40.0%) after CLAG, 0 and 1 (20%) after CLAG/MMC, 1 (100%) and 1 (50%) for AMT, and 1 (60%) after AMT/MMC for recurrent. As plain bare sclera excision had the highest recurrence rates, odds ratios were calculated for each surgical technique as compared to BS. Among all surgical excisions (primary and recurrent), BS with MMC and any graft surgery (SCAG, CLAG, AMT) with MMC were both significantly less likely to result in recurrence as compared to BS alone (p=0.006 and p=0.02 respectively). CLAG alone was also less likely to result in recurrence (p=0.0009).
In our study, the plain bare sclera technique resulted in the highest amount of pterygium recurrences, while CLAG had the lowest amount of recurrences. Adjunctive MMC contributed to decreased recurrence rates in all techniques of pterygium excision. Larger controlled trials should help to further delineate these trends.
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