Download PDF
Klin Monbl Augenheilkd
DOI: 10.1055/a-1648-4753
Klinische Studie

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery

Erleichterte Tenon-Kapsel-freie konjunktivale Autograftvorbereitung und begrenzte Tenon-Kapsel-Entfernungstechnik in der Pterygiumchirurgie
Fikret Ucar 
1   Ophthalmology, Private Konyagoz Hospital, Konya, Turkey
,
Lutfi Seyrek
1   Ophthalmology, Private Konyagoz Hospital, Konya, Turkey
,
Servet Cetinkaya
1   Ophthalmology, Private Konyagoz Hospital, Konya, Turkey
,
Huseyin Ture
2   Ophthalmology, Karaman Selcuklu Hospital, Karaman, Turkey
,
Ekrem Kadioglu
1   Ophthalmology, Private Konyagoz Hospital, Konya, Turkey
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration.

Material and Methods This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017.

Results The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 – 7) minutes in group 1 and 8.23 ± 1.26 (8 – 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001).

Conclusions The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

Zusammenfassung

Ziel Die Hauptkomplikation der primären Pterygiumchirurgie ist das Wiederauftreten des Pterygiums. In der vorliegenden Studie wollten wir die klassische Technik und die erleichterte Technik der Tenon-Kapsel-freien konjunktivalen Autograftpräparation mit der limitierten Technik der Tenon-Kapsel-Entfernung in der Pterygiumchirurgie hinsichtlich Rezidivrate, Komplikationen und Operationsdauer vergleichen.

Methoden Dies ist eine retrospektive, vergleichende Beobachtungsstudie. Gruppe 1 umfasste 120 Augen von 115 Patienten, die sich zwischen Mai 2017 und Oktober 2019 einer Pterygiumexzision mit einer neuen erleichterten Tenon-Kapsel-freien konjunktival-limbalen Autotransplantatpräparation und einer limitierten Tenon-Kapsel-Entfernungstechnik unterzogen. Gruppe 2 umfasste 117 Augen von 113 Patienten, bei denen zwischen Januar 2016 und Mai 2017 eine Pterygiumexzision mit konventioneller konjunktival-limbaler Autografttechnik durchgeführt wurde.

Ergebnisse Die mittlere Nachbeobachtungszeit nach der Operation betrug 18,2 ± 5,8 Monate in Gruppe 1 und 19,1 ± 6,3 Monate in Gruppe 2 (p = 0,25). Die mittlere Operationsdauer betrug 5,54 ± 1,22 (4 – 7) Minuten in Gruppe 1 und 8,23 ± 1,26 (8 – 10) Minuten in Gruppe 2 (p = 0,02). Ein Lappenödem war in Gruppe 2 bei 33 Augen (28,2%) und in Gruppe 1 bei 11 Augen (9,16%) vorhanden. In Gruppe 2 war das Lappenödem signifikant höher (p < 0,001). Am Ende der 1-jährigen Nachbeobachtung der Patienten beobachteten wir ein Rezidiv in nur 1 (0,83%) Auge in Gruppe 1 und 14 (11,96%) Augen in Gruppe 2. Die Rezidivrate von Gruppe 1 war signifikant geringer als die von Gruppe 2 (p < 0,001).

Schlussfolgerungen Die vereinfachte Technik der Tenon-Kapsel-freien konjunktivalen Autotransplantatpräparation und der begrenzten Entfernung der Tenon-Kapsel führte zu besseren klinischen Ergebnissen ohne schwerwiegende Komplikationen. Darüber hinaus verkürzte diese Technik die Operationszeit und reduzierte die chirurgenabhängigen Faktoren.

Key words

pterygium surgery - recurrence - tenon-free conjunctival autograft - limited tenon removal

Schlüsselwörter

Pterygiumchirurgie - Wiederauftreten - Tenon-Kapsel-freies Bindehautautotransplantat - begrenzte Entfernung der Tenon-Kapsel


Publication History

Received: 28 July 2021

Accepted: 25 August 2021

Article published online:
08 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kim KW, Park SH, Kim JC. Fibroblast biology in pterygia. Exp Eye Res 2016; 142: 32-39
    CrossrefPubMedGoogle Scholar
  • 2 Gulani A, Dastur YK. Simultaneous pterygium and cataract surgery. J Postgrad Med 1995; 41: 8-11
    PubMedGoogle Scholar
  • 3 Kaufman SC, Jacobs DS, Lee WB. et al. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. Ophthalmology 2013; 120: 201-208
    CrossrefPubMedGoogle Scholar
  • 4 Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol 2021; DOI: 10.1177/25158414211020152.
    CrossrefPubMedGoogle Scholar
  • 5 Yalcin Tok O, Burcu Nurozler A, Ergun G. et al. Topical cyclosporine A in the prevention of pterygium recurrence. Ophthalmologica 2008; 222: 391-396
    CrossrefPubMedGoogle Scholar
  • 6 Yang HK, Lee YJ, Hyon JY. et al. Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1451-1457
    CrossrefPubMedGoogle Scholar
  • 7 Nadarajah G, Ratnalingam VH, Mohd Isa H. Autologous Blood Versus Fibrin Glue in Pterygium Excision With Conjunctival Autograft Surgery. Cornea 2017; 36: 452-456
    CrossrefPubMedGoogle Scholar
  • 8 Kim SH, Oh JH, Do JR. et al. A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. Cornea 2013; 32: 1578-1581
    CrossrefPubMedGoogle Scholar
  • 9 Zheng K, Cai J, Jhanji V. et al. Comparison of pterygium recurrence rates after limbal conjunctival autograft transplantation and other techniques: meta-analysis. Cornea 2012; 31: 1422-1427
    CrossrefPubMedGoogle Scholar
  • 10 Ozer A, Yildirim N, Erol N. et al. Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions. Ophthalmologica 2009; 223: 269-273
    CrossrefPubMedGoogle Scholar
  • 11 Hirst LW. Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation. Ophthalmology 2008; 115: 1663-1672
    CrossrefPubMedGoogle Scholar
  • 12 Ciftci S, Dogan E, Dag U. et al. Removal of Tenon fortified by conjunctival-limbal autograft in treatment of pterygium. Int Ophthalmol 2017; 37: 813-818
    CrossrefPubMedGoogle Scholar
  • 13 Graue-Hernandez EO, Córdoba A, Jimenez-Corona A. et al. Practice Patterns in the Management of Primary Pterygium: A Survey Study. Cornea 2019; 38: 1339-1344
    CrossrefPubMedGoogle Scholar
  • 14 Chen PP, Ariyasu RG, Kaza V. et al. A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 1995; 120: 151-160
    CrossrefPubMedGoogle Scholar
  • 15 Clearfield E, Hawkins BS, Kuo IC. Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2017; 182: 8-17
    CrossrefPubMedGoogle Scholar
  • 16 Al Fayez MF. Limbal-conjunctival vs. conjunctival autograft transplant for recurrent pterygia: a prospective randomized controlled trial. JAMA Ophthalmol 2013; 131: 11-16
    CrossrefPubMedGoogle Scholar
  • 17 Farrah JJ, Lee GA, Greenrod E. et al. Outcomes of autoconjunctival grafting for primary pterygia when performed by consultant compared with trainee ophthalmologists. Clin Exp Ophthalmol 2006; 34: 857-860
    CrossrefPubMedGoogle Scholar
  • 18 Ti SE, Chee SP, Dear KB. et al. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol 2000; 84: 385-389
    CrossrefPubMedGoogle Scholar
  • 19 Kuo MX, Sarris M, Coroneo MT. Cadaveric Porcine Model for Teaching and Practicing Conjunctival Autograft Creation. Cornea 2015; 34: 824-828
    CrossrefPubMedGoogle Scholar
  • 20 Fuest M, Liu YC, Yam GH. et al. Femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery. Ocul Surf 2017; 15: 211-217
    CrossrefPubMedGoogle Scholar
  • 21 Hirst LW. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. Ophthalmology 2012; 119: 2205-2210
    CrossrefPubMedGoogle Scholar
  • 22 Sati A, Shankar S, Jha A. et al. Comparison of efficacy of three surgical methods of conjunctival autograft fixation in the treatment of pterygium. Int Ophthalmol 2014; 34: 1233-1239
    CrossrefPubMedGoogle Scholar
  • 23 Singh PK, Singh S, Vyas C. et al. Conjunctival autografting without fibrin glue or sutures for pterygium surgery. Cornea 2013; 32: 104-107
    CrossrefPubMedGoogle Scholar
  • 24 de Wit D, Athanasiadis I, Sharma A. et al. Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series. Eye (Lond) 2010; 24: 1474-1477
    CrossrefPubMedGoogle Scholar
  • 25 Kwon SH, Kim HK. Analysis of recurrence patterns following pterygium surgery with conjunctival autografts. Medicine (Baltimore) 2015; 94: e518
    CrossrefPubMedGoogle Scholar