Purchase this article with an account.
Enrique O Graue-Hernandez, Alejandro Navas, Arturo J Ramirez-Miranda, Aida Jimenez-Corona, Juan Carlos Serna-Ojeda, Mark J Mannis; Primary Pterygium Survey: Internet based expert opinion. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1343.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To analyze the preferred practice patterns of cornea and external disease experts around the world regarding pterygium surgery
Internet based survey in kera-net, a worldwide forum in the area of cornea. Questions analyzed expertise, surgical indications, preoperative and postoperative medications, surgical technique, adjunctive therapy, counseling and recurrences. For the purpose of comparisons surgeons were grouped with <10 y of experience (group 1) (group 2)and >10 y. Statistical analysis: chi2 for categorical variables, students t-test for mean , comparison of rank-sum Wilcoxons tests for median and comparison of continuous variables.
210 surgeons included. Expertise: 49.5 % were 40 to 59 years old . 58.5 % . 95% are fellowship trained in cornea. 25.7% perform >30 surgeries per year 54.4% 10-30. Indications for surgery: 98.1%, 96.2% , 92.9%,and 90.9% indicated surgery for proximity to visual axis, astigmatism, restriction of movement and relief of symptoms respectively. Only 40.9% considered cosmesis as a sole indication. When compared group 1 51.7% vs group 2 32.5 % indicated surgery for cosmesis (p=0. 005). Surgical technique: 69.9% perform extensive head and conjunctival resection with 35% resecting up to the caruncle. The most common method of conjunctival replacement was conjunctival autograft by 69.3%. Fibrin glue was used by 61%, vycril continues sutures by 35% . Fibrin glue was more common in group 1 surgeons 69.9% vs 54% (p=0.03) and nylon interrupted sutures more common in group 2 29.9% vs 16.9 % (p=0.035). The most common intraoperative adjunctive therapy was corticosteroids with 32.2%. Postoperative regimen: corticosteroids were reported by 99%, being prednisolone acetate the steroid of choice in 66.4%. 77.8 % used anti-inflammatory regime >1 month, with 34% > 3 months. Recurrences: 45.85% estimated the recurrence rate between 1% to 5% and 31.71% considered their recurrence rate < 1%. 68.2% of surgeons do not consider any therapy to prevent recurrences although mitomycin C was used in 25.1% . Whereas corticosteroids were to treat early recurrences 78.2% . 93% of physicians counsel patients to wear UV blocking sunglasses
The best treatment for primary pterygium is still debatable. This online survey explores the various treatments around the world by cornea and external disease experts. The preferred method of surgical treatment of pterygium is still a matter of debate
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only