Although conjunctival autograft is a safe method that is also effective in the prevention of recurrence, fixing the autograft with sutures, prolongs operation time and creates complications relating to the sutures. Graft dehiscence was diagnosed in 7 except recurrence postoperatively were included in this study. Complete pterygium tissue excision, adequate sized conjunctival autograft, thin graft with minimal tenons, proper orientation of the graft, complete coverage of the bare sclera with proper fixation of the graft to the sclera, preventing post-operative inflammation are all prerequisites to minimise the complications. New blood vessels were observed under a slit lamp in PPG and peripheral . We suggest vertical split simultaneous CAT as a safe and useful surgical method for the treatment of recurrent double-headed pterygium; however, longer follow-up is required to confirm the outcome. Prevalence of and risk factors for pterygia in a rural Northern Chinese population. Pterygium is a frequent corneal disease characterized by growing of fibrovascular tissue from the bulbar conjunctiva onto the cornea. The graft was fixed using fibrin glue, Tisseel (Baxter, Vienna, Austria). Patients who had undergone (a) Conjunctival autografting for primary pterygium (CAG) (b) Conjunctival Limbal autografting for recurrent pterygium (CLAG), (c) Vertical split conjunctival autografting (VsCAG) for double head pterygium (primary) were included in the study. 1f and 1g] was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Onay et al. 1,6 Amniotic membrane is a good alternate choice to reduce recurrence in advanced cases with bilateral heads or in patients who might need glaucoma surgery later. With thanks to Ayse Unal Ersonmez and Barbara Reid for editing the article in terms of English. Mild to moderate corneal scarring [Fig. Appointments & Locations Request an Appointment Appointments | 216.444.2020 Symptoms and Causes Diagnosis and Tests This study has summarized the complications of conjunctival autografting in a long term follow up. Our patient was a male field worker and smoker living in Hatay (a sunny city located in the southernmost of Turkey). To the best of our knowledge, this was the second case presentation of bilateral double double-headed pterygium with successful short term management. The .gov means its official. It has been reported that it is due to the drugs effect on multipotential cells and the rapidly proliferating cells of vascular endothelium. The patients complaint was reduced after removing these particles from the eye surface under topical anesthesia. Huerva V, March A, Martinez-Alonso M, Muniesa MJ, Sanchez C. Pterygium surgery by means of conjunctival autograft: long term follow-up. A pterygium is a noncancerous growth that starts in the clear, thin tissue ( conjunctiva) of the eye. Double-headed pterygium contradicts the surgeon regarding simultaneous or two-stage surgery [3, 4]. But, no complications such as infection, corneal thinning or graft dislocation were seen. Comparison of the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation. In other studies, the primary risk factors for pterygium were reported as age, male sex, ultraviolet exposure, outdoor work and smoking [11-23]. In addition, 0.05% cyclosporin A (Restasis, Allergan Pharmaceutical, Irvine, CA, The USA) twice daily was prescribed for 6 weeks postoperatively. The recurrence was defined as fibrovascular tissue growth of 1.5 mm or more beyond the limbus onto the clear cornea with conjunctival dragging. We also offered patient to use postoperative 0.05% cyclosporine for 6 weeks. Preoperative data collection included age, sex, visual acuity, ocular examination, surgical history. It can be noted that it was significantly more in recurrent pterygia about 75.69% (P < 0.05). Li Z, Wu S, Mai J, Xu K, Sun Y, Song Z, et al. Donor Cornea Use in Scleral Surface Reconstruction. Postoperative 1.5-month clinical photograph was shown in Figure 4. No complications such as infection, corneal thinning or graft dislocation were seen during the 1.5-month follow-up. Cagatay H.H., Gokce G., Ekinci M., Koban Y., Daraman O., Ceylan E. Long-term comparison of fibrin tissue glue and vicryl suture in conjunctival autografting for pterygium surgery. Temporal pterygium was larger and excised firstly. modify the keyword list to augment your search. sharing sensitive information, make sure youre on a federal The residual tissue was removed and smoothened with a crescent blade. The recurrence rate was 10.9% (primary), 37.5% (recurrence), and 14.8% (all pterygium) after pterygium excision with amniotic membrane graft in a study by Prabhasawat et al. The problem may occur on one or both eyes. the contents by NLM or the National Institutes of Health. Wolters Kluwer Health HHS Vulnerability Disclosure, Help For more information, please refer to our Privacy Policy. Photograph of the right eye was taken at the end of operation (Figure 3). In another study authors mentioned that sutured limbal conjunctival autografts had a recurrence rate ranging from 0% to 14.29% [9]. Please enable it to take advantage of the complete set of features! Early postoperative complications like dellen, Haematoma beneath the graft/subconjunctival hemorrhage, graft edema, graft retraction/loss of graft, granuloma. One patient (1.08%) applied to the emergency service on the night of the surgery due to intensive pain and irritation. Loss of graft being the commonest cause (16 cases in primary, 5 cases in recurrent pterygia group), followed by retraction of the graft (8 cases and 2 cases) and persistent inflammation (2 cases and 1 case) Table 2. Perfect pterygium surgery should achieve a low or no recurrence rate, negligible complications and good cosmetic outcome [3, 4]. The localized epithelial defect is seen in almost all patients on day 1 of postoperative period, which heals within 24 hours. 1968;176(2):100-25 Fig. Slit photo of the patient was taken (Figure 1). Conjunctiva should cover the sclera up to the limbus and thereby preventing migration of MMC. Complications Outlook Overview Pterygium surgery is a procedure performed to remove noncancerous conjunctiva gro w ths (pterygia) from the eye. Br J Ophthalmol. McAllister IL, et al. This site needs JavaScript to work properly. Avoid holding the fleshy part of the pterygium with traumatic toothed forceps directly on the blood vessel. All the complications were noted during the follow-up period. Kaufman S.C., Jacobs D.S., Lee W.B., Deng S.X., Rosenblatt M.I., Shtein R.M. He was satisfied with his right eye and demanded the same surgery for his left eye. The conjunctival graft was taken from the superior conjunctiva. [15] to evaluate the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium showed that fibrin glue had fewer recurrence rates and the time taken for the surgery was reduced compared to sutures for fixing the conjunctival graft in place during pterygium surgery. In the study of Lee JS et al. . Tel: +905062358670, E-mail: becekurtul@yahoo.com, This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (. Complications Prognosis Additional Resources 5References Disease Entity Pterygium, from the Greek pterygos meaning "wing", is a common ocular surface lesion originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea. (Fig. Radiation damage after pterygium treatment. They also recommended early excision ofpterygiumto reduce the recurrence rate. Systemic examination and complete ophthalmologic examinations were done for all cases. Based on the type of pterygium different type of surgical procedure was performed as mentioned above. The nasal half was released from its base and placed over the nasal bare sclera without changing the orientation. A brief review about the recent literature published in Pubmed without language and time restrictions concerning the etiology, associated risk factors, operation types and management of patients with recurrent pterygium was also discussed. Nassar MK, El-Sebaey AR, Abdel-Rahman MH, El-Ghonemy K, Shebl AM Clinical, pathological, and molecular aspects of recurrent versus primary, 21. According to the study done by Nassar et al.,[20] there was no significant difference between primary and recurrent pterygium histologically, increased bleeding was noted during the excision of recurrent pterygium. A: Cyst formation due to prolapsed Tenons capsule between the graft and conjunctiva. Patients with serious systemic illness, glaucoma, vitreoretinal disorder and ophthalmological diseases such as dry eye syndrome and pemphigoid were excluded from the study. 13 Hence, it is recommended that only high-risk pterygia should receive MMC. [23] The present widely accepted treatment for pterygium is pterygium excision with conjunctival auto-graft,[45] though various other approaches like the bare sclera technique,[6] sliding conjunctival graft,[7] amniotic membrane graft[8] has been done. It covers the sclera (the eye's white area) and extends over the cornea. Goyal JL, Rao VA, Srinivasan R, Agrawal K. Oculocutaneous manifestations in xeroderma pigmentosa. Arrows show conjunctival autografts in place, Slit-lamp photograph of the patients right eye at the postoperative 1.5-month, showing fine corneal opacity in nasal and temporal sides of peripheral cornea. Accessibility A pterygium is a wing-shaped fibrovascular overgrowth from the conjunctiva onto the corneal surface. 13.2.1 Intraoperative Complications 13.2.1.1 Hemorrhage Excessive bleeding can occur in highly vascularized thick pterygium. Background A pterygium is an elevated, superficial, external ocular mass that usually forms over the perilimbal conjunctiva and extends onto the corneal surface. Patients with systemic hypertension should continue their antihypertensive medications to prevent rebleed. Kurna S.A., Altun A., Aksu B., Kurna R., Sengor T. Comparing treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting. Pterygium has been reported also as a work-related disorder [24]. Maharshak I, Avisar R. Bilateral primary pterygia: an occupational disease? Complete dissection of the pterygium body from the sclera, subconjunctival Tenons tissue and surrounding fibrovascular tissues was performed with the Westcott scissors. -, Br J Ophthalmol. The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study. Intraoperative use of antimetabolites, namely mitomycin C (MMC), reduces the risk of recurrence. Wearing of face caps/hats and protective goggles were found to have a protective effect [40, 41]. However, the main issue in pterygium management is recurrence, which is still challenging regarding prevention and management. Graft edema may be seen in the early postoperative period; however, it resolves with topical treatment. The conjunctiva may recede in the early postoperative period and expose the underlying sclera (. No intervention was made in 7 cases in which early disengagement from nasal conjunctiva was observed; it was reported that these cases were epithelialized within one week. (h) Recurrent, (a) Graft sloughing. Drugs to avoid recurrence like mitomycin C or 5-fluorouracil were not used. 15 He observed that beta irradiation to prevent recurrence of pterygia is a significant cause of iatrogenic ocular disease. MMC 0.5 mg/mL has also been used after pterygium excision and beta-irradiation, which leads to complications such as scleromalacia, scleral ulcer, and cataract. 1970 Apr;54(4):237-47 -, Am J Ophthalmol. 2d] were seen in only 1 case (0.04%) who was operated on for recurrent pterygium and scleral melt/scleral perforation did not occur in any of the cases. Postoperative medication is also important and using sunglasses for protection from ultraviolet should be advised to patients with pterygium to lessen the recurrence probability. Effect of orbital protrusion and vertical interpalpebral distance on pterygium formation. A rare type of pterygium is double-headed (both temporal and nasal origins) and bilateral form which is scarcely seen [3]. Ma et al., compared amnion membrane graft and conjunctival autograft combined with MMC treatment, and reported 1% pyogenic granuloma and 1% iatrogenic microhyphema as complications in the amnion membrane group, 1.8% scleral ischemia in the MMC group and 3.6% pyogenic granuloma and 7.3% conjunctival inclusion cyst in the conjunctival autograft group [13]. In this retrospective study, we have tried to analyze the complications post pterygium, both immediate and long term for a better understanding of the complication profile. In such cases, scar exploration and release of fibrosis are usually performed. The bodies of the nasal and temporal pterygium were marked. Early postoperative complications . Of 2356 cases, 2028 patients were included in the study, and these patients were retrospectively analyzed. However, a genetic mutation analysis was not performed in our patient. Sharma V, Tinna A, Singh A, Singh AK, Ambiya V. Indian J Ophthalmol. A literature review was performed based on the results yielded from searching PubMed, Embase, Web of Science, Scopus, and Cochrane database using the follow-ing keywords: pterygium, complications, etiolo- It is usually seen as a triangular fleshy fibrovascular proliferation from the bulbar conjunctiva onto the cornea, located mostly on the nasal side. The complications that have been noted include intra-operative complications like perforation of the globe, thinning of sclera or cornea from dissection, intraoperative bleeding, muscle injury, buttonholing, graft tear. Pterygium. Complications such as temporary graft edema and defects in the corneal epithelium were observed at equal rates in the two groups. The average operation time was shortened in comparison to the suture group. 2004 Jul 15;59(4):1138-47. doi: 10.1016/j.ijrobp.2003.12.021. Cagatay et al. The cut-and-paste method for primary pterygium surgery: long-term follow-up. Careers. Purpose: Analysis of complication profile after pterygium excision, in primary and recurrent pterygia. For primary pterygium, conjunctival autografting was done without including the limbal tissue. At the postoperative first week, first and 1.5-month visits, conjunctival autografts were in place and stable. Sixteen (17.39%) of the 92 patients were detected with a complication. Liang W., Li R., Deng X. [27] mentioned a strong association between dry eye and pterygium. 1e] occurred in 692 cases (29.37%) and sliding of the graft [Fig. Koranyi et al., reported that the operation time had been shortened, postoperative pain was significantly lower, with no complications with using fibrin glue in conjunctival transplantation in pterygium surgery [19]. This may lead to scleral thinning and perforation. The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). 2022 Mar;70(3):783-787. doi: 10.4103/ijo.IJO_1895_21. They concluded that a single dose of 0.5 mg/mL subconjunctivally gives the same results as multiple drops do, but with far less morbidity. Arch Ophthalmol . However, we did not prefer anti-fibroproliferative application because of double sided pterygium. Excess scarring can occasionally cause restrictive strabismus. Pterygium in our patient was not in an advanced size; therefore, we did not need to use multi-layer amniotic membrane. Int J Radiat Oncol Biol Phys. Outcomes of conjunctival autograft in primary pterygium cases in other studies[516171819] are listed in Table 3, in our study largest sample size is been considered. Different surgical techniques for treatment of double-headed pterygium have been applied [3, 4]. In a later study by Koranyi et al. The patients were followed at day 1, 2 weeks, 6 weeks, 6 months initially after the surgery, then every 6 months thereafter. 2b] was present post pterygium excision. -, Br J Ophthalmol. One of the main complications of pterygium surgery is recurrence, in our study the total recurrence rate was 1.44%. He told that his mother and sister had also pterygium. Marticorena J, Rodrguez-Ares MT, Tourio R, Mera P, Valladares MJ, Martinez-de-la-Casa JM, et al. No complications such as infection, corneal thinning or graft dislocation were seen. (Fig. Koranyi G., Seregard S., Kopp E.D. There is only one paper in the literature regarding pterygium-like corneal alterations of three patients in one family complained from persistent recurrences with bilateral symmetrical involvement of the nasal and temporal cornea [9]. 1700 patients had unilateral pterygium, 328 patients had bilateral pterygium. Complications in fibrin glue assisted pterygium surgery are relatively different from other techniques. A pterygium is a fibrovascular tissue that often originates from the nasal bulbar conjunctiva and extends onto the cornea in a wing shape. Pterygium management is mainly surgical. Scleral ulceration was present in 51 eyes on a long-term follow-up by Tarr and Constable. Conjunctiva receded in the immediate postoperative period. Although fibrin glue is a material that shortens operation time, improves postoperative patient comfort and decreases inflammation, patients should be carefully followed in the postoperative time period for any possible complications. The prevalence and determinants of pterygium and pinguecula in an urban population in Shahroud, Iran. 1980 Sep;64(9):676-9. doi: 10.1136/bjo.64.9.676. Scleral dellen is an early postoperative complication of bare sclera technique with MMC owing to delayed conjunctival wound closure. Pterygium postoperative granuloma (PPG) is one of the common complications of pterygium surgery. The possible reasons for the poor adhesion are due to improper application of tissue glue or sutures. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications. These complications include graft edema, hemorrhage or hematoma under the graft, and . Although pterygium is not fully understood, significant progress has been made toward understanding the mechanisms involved . Koranyi G., Seregard S., Kopp E.D. There is a need to modify the beta irradiation dosimetry at present in use. To and transmitted securely.
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