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Min-Gyu Choi, Jae Chan Kim; Decision Making Model for the Operation Method and Prognosis in Pterygium. Invest. Ophthalmol. Vis. Sci. 2018;59(9):129. doi: https://doi.org/.
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The recurrence of pterygium is the most important factor in assessing the success of operation. A rate of recurrence can vary greatly depending on the operation methods. Repeated operations cause serious complications symblepharon, limitation of extraocular muscles and corneal opacity. A lot of operations has been done in various ways to reduce the risk of recurrence, but we don’t have obvious guideline considering risk factor associated with recurrence. The purpose of this study was to develop the decision making model which can determine the operation methods and prognosis in pterygium.
In this retrospective study, 48 patients who treated with operation for pterygium. We investigated duration of pterygium, past ocular history. All patients underwent a comprehensive slit-lamp examination to visualize and grade the palisades of vogt (POV). We scored a skin scars associated with the Bacillus-Calmette-Geurin(BCG) injection site or post-operation according to Kyoto Scar Scale. Optical Coherence Tomography(OCT) images of POV in corneal limbus were acquired using swept-soure OCT (Topcon DRI OCT Triton). The areas below POV in corneal limbus were measured. The grade of POV on slit-lamp examination, the grade of skin scars and the area of shadow below POV in OCT were analyzed to evaluate the correlation of them. We made the decision making tree based on these findings.
Statistical analysis showed significant correlation between the area of POV in OCT and the POV grade on slit-lamp examination (Pearson correlation coefficient 0.786, p<0.001). The area of shadow below POV in OCT can be objective indicator of the grade of POV on slit-lamp. The recurrenc rate was low regardless of the area of POV in lower skin scar score group (4/24, 16.7%). However, The operation methods affect the recurrence rate in larger area of POV group.
The evaluation of skin scar and POV can make us reduce the recurrence rate of pterygium. If the patient has elevated and dense POV and hyptertrophic keloid scar, the ophthalmologist should delay the operation or do extremely complicated operation with high level of difficulty to avoid recurrence.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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