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Adam Sise, Tanuj Banker, Wellington Chang, Sasikala Pillai; Pterygiums: A Resident Experience with Recurrence and Complications. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3104. doi: https://doi.org/.
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To determine pterygium recurrence rates among resident surgical cases and to identify preoperative, intraoperative, and postoperative risk factors for recurrence.
A retrospective chart review of 51 cases from 2008 to 2012 at Georgetown University Hospital. Charts were selected for initial pterygium excisions only, comprising 17 residents with 8 attendings. Most cases involved conjunctival autograft secured with fibrin sealant. Pre-operative demographics, intraoperative methods, and post-operative management were compared with a mean follow-up time of 21 weeks.
The majority of cases (45) were conjunctival autografts. The remaining six cases used amniotic membrane grafts. Only one case used Mitomycin C (MMC) intraoperatively. Thirty-one percent (16/51) of cases developed recurrence. Mean time to recurrence was 10.6 weeks. Hispanic ethnicity (16/45 vs 0/6) was associated with higher recurrence rates. Younger age (37.8 vs 45.1, p= 0.0630) was also associated with recurrence. Use of sutures was not found to correlate with recurrence rate (4/15 vs 12/36, p= 0.7485). Size of the pterygium was not associated with higher recurrence rate. Variations in the dose, frequency, and duration of steroid use did not differ between recurrence and non-recurrence groups.
Resident recurrence rates and complications were comparable to other reports within the literature. The two major risk factors associated with recurrence within this study were Hispanic ethnicity and younger age. Differences in the vigor of the inflammatory response within these groups may underlie the difference in risk. However, the post-operative management with anti-inflammatory medication, including initial frequency, week of first taper, and total duration, was not found to be significantly different between these two groups. Additionally, the use of absorbable sutures, which might enhance the inflammatory response, did not affect the risk of recurrence. Intraoperative use of MMC for initial excisions was rare in this academic setting, but has been used for many excisions of recurrent pterygium. Further investigation of MMC for initial excisions in these high-risk groups may be warranted.
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