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Jeannie Xu, Hyunjoo Jean Lee; Outcomes of double-headed pterygium surgery performed with double conjunctival autografts. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5686.
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© ARVO (1962-2015); The Authors (2016-present)
Double-headed pterygium, the presence of both nasal and temporal pterygia in the same eye, are often treated with a single conjunctival autograft (CAG) and a contralateral amniotic membrane transplantation (AMT), perhaps due to concern about the safety and feasibility of harvesting two CAG from the same eye. We aimed to examine the safety and efficacy of performing double-headed pterygium excision with double CAG by reviewing our cases, and to compare these outcomes to cases performed with single CAG and contralateral AMT.
A retrospective chart review of double pterygium surgery cases at Boston Medical Center performed between September 2013 and November 2016 by a single surgeon was conducted. Outcome measures included: rate of pterygium recurrence, pre-operative and post-operative BCVA, and complications.
9 eyes of 7 patients who underwent double pterygium surgery were identified. 5 eyes received double CAG alone, and 2 eyes received double CAG to cover the limbal defects, supplemented with AMT to cover any remaining posterior conjunctival defect at the excision sites. 2 eyes of the same patient received a single CAG, and AMT was used to cover the entire contralateral defect, due to concern about mild glaucoma suspicion. None of the surgeries involved mitomycin-C application. No recurrences were noted in the 7 eyes in which double CAG ± supplemental AMT was performed (0 of 7 eyes, follow-up 0.25-12 mo, avg 3.6 mo). In eyes with single CAG and contralateral AMT, 1 pterygium recurrence occurred at the site of a temporal AMT at 6 months (1 of 2 eyes, follow-up 5-9 mo, avg 7 mo). The average pre-operative and final post-operative logMAR BCVA was 0.55 ± 0.60 SEM (Snellen equivalent 20/70) and 0.07 ± 0.15 SEM (20/24) in the double CAG group and 0.20 ± 0.28 SEM (20/32) and 0.05 ± 0.07 SEM (20/22) in the single CAG+AMT group, respectively. No complications were identified with performing either a double CAG or single CAG+AMT. In particular, no limbal stem cell deficiencies or complications of graft harvest site healing were noted with double CAG.
The use of double CAG to cover all limbal defects in cases of double pterygium excision was not associated with any complications, and was associated with a low pterygium recurrence rate. The use of double CAG or single CAG+AMT for double pterygium excision was associated with good visual outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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