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A. Schrier, S. Lalin, B. Schechter, E.F. Smith, D. Srinivasan; Recurrence Rates in Pterygium Excision: Nylon Versus Vicryl Sutures in Conjunctival Autografts . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1319.
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Purpose: Previous reports have noted that pterygia rarely recur when treated with conjunctival autografts secured with vicryl sutures. We observed a high incidence of pterygium recurrence in an urban Dominican population treated with 7-0 or 8-0 vicryl sutures. In this study, we compared the pterygium recurrence rates using 10-0 nylon sutures versus 7-0 or 8-0 vicryl sutures in treating primary and recurrent pterygia with conjunctival autografts in this same Dominican population. Methods: A prospective, randomized comparative study was done. 24 eyes of 22 patients of Dominican heritage with primary or recurrent pterygia were operated on by one surgeon. 10-0 nylon sutures were used to secure the conjunctival autograft in 10 eyes of 9 patients, while 7-0 or 8-0 vicryl sutures were used in 14 eyes of 13 patients. All the patients had excision of their pterygia. The bare sclera and exposed limbus were then covered with a similar-sized conjunctival autograft harvested from the superior conjunctiva. The post-operative regimen consisted of 0.1% dexamethasone and 0.3% tobramycin combination drops taken four times daily which were gradually tapered over four to six weeks. Results: The mean post-operative follow-up time was 9.04 months (6 months to 14 months). The corneal recurrence rate (Grade 4) for the 10-0 nylon sutures were 0.0%, while the corneal recurrence rates for the vicryl sutures were 35.7% during the same post-operative interval. The conjunctival recurrence rates for the 10-0 nylon sutures were 11.1% for Grade 1 (fibrovascular recurrence not affecting the conjunctival autograft), 0.0% for Grade 2 (fibrovascular recurrence affecting up to 50% of the distal aspect of the graft from the limbus), and 0.0% for Grade 3 (fibrovascular recurrence affecting 50-100% of the graft but not involving the cornea). In contrast to the nylon sutures, the vicryl sutures had higher conjunctival recurrences (7.1% Grade 1, 0% Grade 2, and 14.2% Grade 3). Conclusions: We conclude that 10-0 nylon sutures are more effective than vicryl sutures in preventing pterygium recurrences in this cohort of Dominican patients treated with conjunctival autografts. We hypothesize that the higher recurrence rates with vicryl sutures may be attributed to a more vigorous inflammatory response in contrast to the conjuctival autografts secured with10-0 nylon sutures.
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