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Sahitya Podila, Gina Nguyen, Orrin Myers, Linda Rose; Comparison of the P.E.R.F.E.C.T. and a modified amniotic membrane graft version of the technique for pterygium removal.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6251. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Studies of the pterygium extended removal followed by extended conjunctival transplant (P.E.R.F.E.C.T.) method of pterygium removal surgery have demonstrated an extremely low recurrence rate. We performed a retrospective, observational clinical study to report the outcomes of this technique, and those of the same surgical technique employing amniotic membrane graft (AMG) instead of a conjunctival autograft.
We studied eyes of adult patients who underwent primary and recurrent pterygium surgery by a single experienced surgeon from January 2011 to August 2018. During this time both techniques were used. Post-operative follow up evaluations were conducted at one day, one week, one month, four months, and one year to assess recurrence, complications, narcotic prescription, and total amount of steroid drop use. Relative frequencies of categorical variables were analyzed using Chi-square and Fisher exact tests, and non-parametric Wilcoxon tests were used to analyze continuous variables. Duration of steroid use (days) for the two techniques were compared using Kaplan-Meier survival analysis and log-rank tests.
The study included 297 eyes with 226 treated by standard P.E.R.F.E.C.T. and 71 treated with the same surgical technique employing AMG. The median length of surgery was 51.0 minutes for the P.E.R.F.E.C.T. technique and 37.0 minutes for the AMG group, and was significantly shorter in the AMG group of patients (P=<.0001). There were 3 conjunctival recurrences with each of the techniques with percentage recurrence not significantly different for the two groups, 4.1% AMG and 1.3% P.E.R.F.E.C.T., P = 0.158. Narcotics were prescribed at 1 day post op to 8 patients (3.5%) in the PERFECT group and 2 patients (2.8%) in the AMG group based on reported pain and clinician discretion. Median duration of steroid use was 54 days (95% CI 37 – 67) for AMG compared to 85 days (95% CI 73 – 92, log-rank test P = 0.002) for the PERFECT group.
Our experience shows that the modified technique using AMG provides a faster alternative with shorter steroid use than the PERFECT technique for pterygium removal.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Kaplan-Meier curve with estimates for duration of steroid use. Median duration of steroid use was 54 days (95% CI 37 – 67) for AMG compared to 85 days (95% CI 73 – 92, log-rank test P = 0.002) for the PERFECT group.
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