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W. G. Hodge, B. McCurdy, A. Slomovic; Limbal Stem Cell Transplantation Compared to Other Adjuvant Therapies After Pterygium Excision: A Meta-Analysis of Available Randomized Clinical Trials. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5046.
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To perform a meta-analysis of existing randomized clinical trials (RCT's)comparing Limbal Stem Cell Transplantation (LSCT) to other adjuvant therapies (conjunctival autografts-CAU, amniotic membrane transplants-AMT and mitomycin C application-MMC)after primary pterygium excision.
Electronic databases searched included OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Library, and INAHTA/CRD to identify studies published between January 1, 2000 and May 16, 2008 related to LSCT for the treatment of pterygium. Additional studies were identified from the reference lists of included studies. RCT's needed follow up of at least 6 months to be included. The GRADE system was used to assess evidence quality. Standard Forest Plots were constructed to summarize data with the relative risk of pterygium recurrence as the a priori primary outcome.
The search yielded 152 citations published between January 1, 2000 and May 16, 2008. Six RCT's met the inclusion criteria. LSCT significantly reduced the risk of pterygium recurrence compared to CAU (RR, 0.09; 95% CI, 0.01-0.69; P = .02). LSCT reduced the risk of pterygium recurrence compared to MMC, but this comparison did not reach statistical significance (RR, 0.48; 95% CI, 0.21-1.10; P = .08). AMT and LSCT had similar low rates of recurrence (2 recurrences in 43 patients and 4 in 46, respectively), and the relative risk was not significant (RR, 1.88; 95% CI, 0.37-9.5; P = .45).
LSCT appears at least as effective as other modalities to prevent recurrence of primary pterygium though at this time it is only clearly superior to isolated CAU.
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