Mahar P, Manzar N. Risk factors involved in pterygium recurrence after surgical excision. Zhao L, You QS, Xu L, Ma K, Wang YX, Yang H, et al. Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: Recurrence rate and cosmesis. The mean complete epithelialization was 12.6 7.6 days and no surgical complications were observed. 5-FU was adopted as a routine in the treatment of pterygium by some authors.8,15 In the Said et al. pointed out the benefits of using fibrin glue versus sutures in terms of recurrence rate.66 However, Kucukerdonmez et al.52 did not confirm the superiority of fibrin glue. Adjuvant therapy, Amniotic membrane graft/transplant, Conjunctival autograft, Conjunctival disease, Pterygium, Pterygium management, Pterygium recurrence, Recurrent pterygium, Risk factor. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. However, the literature is still updating with newer surgical and/or nonsurgical methods to decrease the recurrence and improve the cosmetic outcomes. This led to choosing AMT instead of CAU by some surgeons. Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: A long-term follow-up study. Comparison of Pterygium Recurrence Rates Among Different : Cornea Farid M, Pirnazar JR. Pterygium recurrence after excision with conjunctival autograft: A comparison of fibrin tissue adhesive to absorbable sutures. 126 Some studies compared results . Results. Rural region of habitation, lower fasting blood glucose, LCAU is superior to CAU in recurrent pterygium surgery, Early graft retraction, ocular surface inflammation, Fibrin glue instead of suture, CAU is superior to AMT, LCAU combined with MMC results in a better cosmetic appearance and lower recurrence, 2 months after pterygium surgery with bare sclera and MMC: Topical bevacizumab eyedrops (25 mg/mL) 4 times daily for 3 weeks, Topical bevacizumab may be effective to prevent recurrence in a patient with impending recurrent pterygium, After pterygium surgery with bare sclera and MMC: 26 patients received bevacizumab eyedrops (5 mg/ml) twice daily and betamethasone eyedrops 4 times daily for 1 week; 28 patients received betamethasone only, Short-term topical bevacizumab helped with delaying the onset of recurrence in cases of impending recurrent pterygium, A single intralesional injection of bevacizumab in impending recurrent pterygium: 20 patients received 1.25 mg; 20 patients received 2.50 mg; 20 patients received 3.75 mg; 20 patients served as control, A single subconjunctival bevacizumab injection decreased conjunctival vascularization in a dose-dependent manner partially and transiently. This technique included extensive tenonectomy and pterygium resection followed by the transplantation of a large CAU, which led to very low recurrence rates (0.1% for 1000 patients) in primary and recurrent cases.50 In 2015, Katircioglu et al. However, pterygium surgery is concerned with high rates of postoperative recurrence. Recurrence is your worst enemy. The results were not different between groups 1 year after the operation. Pterygia: Pathogenesis and the role of subconjunctival bevacizumab in treatment. Simple limbal epithelial transplantation for recurrent pterygium: A case series. Hall RC, Logan AJ, Wells AP. PMID: 25320400 PMCID: PMC4196535 DOI: 10.4314/gmj.v48i1.6 Abstract Objectives: To determine the epidemiology and recurrence rate of pterygium after excision using bare sclera technique. Ocular demodicosis as a risk factor of pterygium recurrence. Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium. also confirmed the same finding.43 In contrast, in a prospective study of 190 patients, larger preoperative size of the pterygium was confirmed as a protective factor against recurrence following CAU or limbal conjunctival autograft (LCAU) surgeries.18 It is important to mention that published studies in this aspect differ substantially not only in methodological aspects but also in their observation period, the usage of adjuvant medication, sample size, and measuring approach.17 Anguria et al. We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Pterygium Article - StatPearls The inclusion criterion was recurrent pterygium. Rykov SO, Usenko KO, Mogilevskyy S, Ziablitsev SV, Denisiuk LE. included 31 eyes with recurrent pterygia and followed the patients for about 3.6 years. Phase I study of subconjunctival ranibizumab in patients with primary pterygium undergoing pterygium surgery. Several small studies have been performed to evaluate the role of perioperative 5-FU with or without concomitant corticosteroids in the management of recurrent pterygium since 2001.19,64 The initial results have been promising. PDF PTERYGIUM; - World Health Organization Comparison of efficacy of three surgical methods of conjunctival autograft fixation in the treatment of pterygium. DED perpetuates ocular surface inflammation in the postoperative period, and this inflammation may increase the rate of recurrence.14,77 Proper and early diagnosis and management of DED in the perioperative period could reduce the risk of recurrence.14,34. Pathogenic role of demodex mites in blepharitis. Barbosa JB, De Farias CC, Hirai FE, Pereira Gomes J. Amniotic Membrane Transplant - EyeWiki Srinivasan S, Dollin M, McAllum P, Berger Y, Rootman DS, Slomovic AR. These various rates of recurrence have been attributed to different concentrations and patching times of the MMC cotton applicator, as well as to the surgical technique used. Correlation between ocular demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea. This was consistent with low recurrence rate, which was one case of recurrence in the 1000 surgeries (0.1%). Pan HW, Zhong JX, Jing Cx. The overall recurrence rate was 34.5% (19/55 cases). Many authors recommend these drugs as an alternative to surgery in some patients. Peng ML, Tsai YY, Tung JN, Chiang CC, Huang YC, Lee H, et al. Therefore, the exact time of pterygium recurrence cannot be accurately calculated as most patients are followed up for only 1 year and it may not be long enough in some eyes. To treat the pterygium, surgical excision is one of the commonly used methods, but the recurrence rate can be high after its surgical removal . Li J, OReilly N, Sheha H, Katz R, Raju VK, Kavanagh K, et al. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. Tsim NC, Young AL, Jhanji V, Ho M, Cheng LL. All four studies showed a lower pterygium recurrence rate in conjunctival or limbal autograft groups (P=0.05). reported their finding on recurrent pterygium cases treated with AMT combined with 0.02% MMC for 1 min or CAU combined with the same dose of MMC.10 They found a similar recurrence rate in both groups. Razeghinejad MR, Hosseini H, Ahmadi F, Rahat F, Eghbal H. Preliminary results of subconjunctival bevacizumab in primary pterygium excision. The recurrence of pterygium after different modalities of surgical treatment. Mushtaq et al. There is yet to be a panacea in treating recurrent pterygium. 155,157,179 A meta-analysis of 20 studies in 2016 revealed that AMT is associated with a higher risk of recurrence 6 months after surgery, compared with conjunctival autografting, and the inferiority of AMT is present in both primary and recurrent pterygia. . CAU represents the current gold standard treatment for primary pterygium. They suggested that AMT-MMC is an acceptable method for the treatment of recurrent pterygium cases, with similar outcomes and complication rates.10 Barbosa et al. Nava-Castaeda A, Ulloa-Orozco I, Garnica-Hayashi L, Hernandez-Orgaz J, Jimenez-Martinez MC, Garfias Y. 8 The maximum prevalence rate for pterygium has been reported in a Chinese study on rural population, where a rate of . Currently,. Method: Prospective randomized clinical trial. Purpose:To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians.Methods:This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. Comparison of Pterygium Recurrence Rates Between Attending : Cornea The recurrence of pterygium after different modalities of surgical Rosen R. Amniotic membrane grafts to reduce pterygium recurrence. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: Clinical perspectives. In conclusion, to evaluate pterygium recurrence properly, the postoperative follow-up assessment should be at least 12 months.8,11,17 It has been noticed that most recurrences occur within the first 36 months after surgery.28, Some researchers believe that if later recurrences are taken into account, there may be a significantly greater recurrence rate than previously reported.17 There are studies with a median follow-up of 12 years51 or even up to 18 years.43 Kucukerdonmez et al. Risk factors associated with pterygium and its subtypes in Korea: The Korean National Health and Nutrition Examination Survey 2008-2010. Subconjunctival and topical application are the most popular administration techniques. Many authors have evaluated the use of anti-VEGF drugs as an adjuvant treatment after surgical resection. Changes of tear film function after pterygium operation. Incomplete control of postoperative inflammation, surgical techniques such as excessive suturing and incomplete removal of the primary pterygium, young age, surgeon experience, higher morphologic grade (fleshiness of pterygium), heavy vascularization of the primary pterygium, and black race are other risk factors for recurrence of the pterygium.9,10,11,12,13,14,15,16,17,18,19,20,21,22 In addition, the precise pathogenesis of recurrence is under debate. However, in some studies, AMT was compared with CAU without using intraoperative MMC. did not show an association between the fleshiness of pterygium and recurrence.18 They showed that eshiness of pterygium protected older patients from pterygium recurrence after excision, and they concluded that eshiness was not an important factor for the recurrence. Kucukerdonmez C, Karalezli A, Akova YA, Borazan M. Amniotic membrane transplantation using fibrin glue in pterygium surgery: A comparative randomized clinical trial. 1Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, 2Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, 3Department of Radiation Oncology, Indiana University, Indiana, USA, 4Alavi Eye Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. compared the outcomes of an LCAU with those of an AMT to treat recurrent pterygium.11 The authors used intraoperative 0.02% MMC for 3 min before carrying out LCAU or AMT. Kampitak et al. Monden Y, Nagashima C, Yokote N, Hotokezaka F, Maeda S, Sasaki K, et al. The importance of the protective effect of sunglasses, especially for high-risk individuals, is clearly demonstrated in multiple studies.4,57 Ocular Demodex infestation has recently been identified as an overlooked risk factor for pterygium recurrence. Overexpression of vascular endothelial growth factor receptor 2 in pterygia may have a predictive value for a higher postoperative recurrence rate. Most patients were satisfied with the cosmetic outcome. Multimicroporous e-PTFE, preserved limbal allograft and AMT, the SLET technique, and LCAU combined with the widening of the limbal incision are among novel ways to reduce recurrence. Therefore, a larger graft is needed to close this defect. They concluded that LCAU with the additional widening of the limbal incision was more effective in terms of reducing pterygium recurrence than CAU alone. The main proven risk factors for primary pterygium are cumulative ultraviolet (UV) light exposure, prolonged sunlight exposure (more than 5 h per day), having an outdoor occupation, aging, dry eye disease (DED), male gender, and genetic factors such as p53 tumor suppressor gene and ethnicity.1,2,3,4,5,6,7,8 However, only some of these risk factors may be responsible for the development of a recurrent pterygium.
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