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Seika Den, Yoshiyuki Satake, Naohiko Nakayama, Takefumi Yamaguchi, Jun Shimazaki; Standardized strategy and long-term surgical outcomes in primary and recurrent pterygium. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3495.
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Mitomycin C (MMC) application to prevent recurrence is controversial in both primary and recurrent pterygium surgery. We studied recurrence rates and long-term outcomes of surgeries performed by standardized strategy in use of MMC.
A single center, retrospective chart review was performed on consecutive subjects with primary or recurrent pterygium that received pterygium excision and conjunctival flap (CF). MMC application was standardized as following; 1. no application for primary pterygium, 2. amniotic membrane transplantation (AMT) without MMC for recurrent pterygium not accompanied with symblepharon/diplopia, 3. AMT with MMC for recurrent pterygium with either younger age than 55 years, more than twice past surgeries or MMC use in past even if not accompanied symblepharon/diplopia, 4. AMT with MMC for recurrent pterygium accompanied with symblepharon/diplopia. We defined 1 as primary group (P), 2 as recurrent pterygium without MMC group (REC) and 3 plus 4 as recurrent pterygium with MMC (REC-MMC). The eyes followed more than 12 weeks were included. We investigated surgical outcomes and the factors influenced recurrence rate among three groups.
Of 414 primary pterygia, 295 eyes were included in this study (P group, mean age 65±10 yrs, mean follow-up 18±15 months). Conjunctival free flap (CFF) and rotational flap (CRF) were performed in 143 eyes and 152 eyes, respectively. Overall recurrence rate was 3.4% (10 eyes), and those of the two groups of CFF and CRF were not significantly different. Recurrence cases were significantly younger (50±12 yrs) than successful cases (65±10 yrs) (P=0.00001). Of 277 recurrent pterygia, 63 eyes in REC group (61±12 yrs, 17±18 months) and 60 eyes in REC-MMC group (63±12 yrs, 17±17 months) were also studied. Recurrence was noted in 8 eyes (12.7%) and 4 eyes (6.7%) in the REC and REC-MMC group, respectively, and the difference was not significant. We did not find any factors influenced recurrence including age and the number of past surgeries. There were no vision-threatening complications in all groups.
CF without MMC for primary pterygium is effective means of preventing recurrence, however younger subjects should be pay attention to recurrence. AMT provides satisfactory outcomes in recurrent pterygium surgery. MMC application may be considered for limited severe cases.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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