Optimizing Office-Based Pterygium Surgery

Abstract

Purpose : Pterygia are common, with a prevalence as high as 23% in certain populations, and pterygium excision surgery requires significant operating room time and cost. Office-based surgery offers a more cost-effective and accessible alternative. In this study, we compare pterygium recurrence between surgeries done in the operating room (OR) and the office-based minor procedure room, and between surgeries using fibrin glue and sutures.

Methods : We performed a chart review of patients who underwent pterygium excision surgery at the Zuckerberg San Francisco General Hospital from 2014 to 2022. The primary outcome was recurrence rate at postoperative year 1. Data were analyzed with Fisher’s exact or chi square tests for categorical variables and t-tests for continuous variables.

Results : A total of 203 patients underwent pterygium excision surgery during the study period: 28% patients with fibrin glue in the OR, 34% patients with fibrin glue in the office, and 37% patients with sutures in the office. No patients had any intraoperative complications. There was no significant difference between pterygium recurrence across all office-based procedures (28.1%) and all OR-based procedures (17.9%, P=0.12). Pterygium recurrence across all suture procedures (42.1%) was significantly higher than recurrence across all fibrin glue procedures (15.0%, P<0.001). Pterygium recurrence was higher in the office suture group (41.2%) compared to the OR fibrin glue (17.9%, P=0.003) and office fibrin glue (12.9%, P<0.001) groups, with no significant difference between the OR and office fibrin glue groups (P=0.46). Time to recurrence was greater in the office suture group (5.7 months) compared to the OR fibrin glue (4.6 months, P=0.02) and minor procedure room fibrin glue (5.3 months, P=0.14) groups, with similar reoperation rates across all groups.

Conclusions : Pterygium recurrence was significantly higher with the use of sutures compared to fibrin glue, with no difference in recurrence between fibrin glue excisions performed in the OR and the minor procedure room. These findings show that the use of fibrin glue may result in a lower recurrence rate than suture, and highlight the potential of performing high-volume, cost-effective pterygium excision surgery in an office-based setting.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1: Pterygium Excision Surgeries at the Zuckerberg San Francisco General Hospital from 2014-2022