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Catherine Q Sun, Matilda F Chan, Sriranjani Padmanabhan, Julie Marie Schallhorn, Jennifer Rose-Nussbaumer, Ariana Naaseh, Marie Wolf, Selene M. Clay, Michele Bloomer; Optimizing Clinic-Performed Pterygium Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4366.
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© ARVO (1962-2015); The Authors (2016-present)
The prevalence of pterygia is estimated to be 10.2% and the large number of patients needing pterygium surgery creates a significant burden on the allocation of operating room time. In this retrospective, observational study, we evaluated the predictors of recurrence after outpatient, clinic-performed surgery with conjunctival autograft for primary pterygia.
Patients with primary pterygia causing significant irritation or compromised vision who underwent pterygium excision with sutured conjunctival autograft in the minor procedure room at the Zuckerberg San Francisco General Hospital were followed from June to November 2016. Exclusion criteria included large pterygia requiring amniotic membrane graft and double-headed pterygium. The primary outcome was recurrence rate. Data were analyzed using Fisher’s exact test or chi-square test for categorical variables and paired t-test for normally distributed interval variables.
Of the 34 study participants, 28 (82%) were female with a mean age of 50 years (SD 11.2 years). The majority had nasal pterygium (N=33) with a mean size of 3.20mm (SD 0.98) by 5.08mm (SD 1.21). 6 patients (18%) had prior primary pterygium surgery in the fellow eye and 2 of those were complicated by recurrence in the fellow eye. There were 3 recurrences (9%) in the operative eye between postoperative months 1 to 4 (mean 2.53 months, SD 1.45). Minor adverse effects included steroid-induced ocular hypertension in 6 (18%) patients who required topical medication and 1 (2%) patient with a mild allergic reaction to neomycin, polymyxin B sulfates and dexamethasone. No correlation was found between recurrence and ocular hypertension (P=0.55), medication noncompliance (P=0.55), history of recurrence in the fellow eye (P=0.83), older age (P=0.76) or larger pterygium size (P=0.63).
Our clinic-based method of performing primary pterygium excision results in a recurrence rate of 9% at postoperative month 3 that is comparable to rates reported in the literature using conjunctival autograft in an operating room setting (0 to 12.5%). This study highlights the potential of performing high-volume, cost-effective pterygium surgery in an outpatient clinic setting without monitored anesthesia care, and provides support for studying this on a larger scale.
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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