et al. ObjectiveTo report a new grading system and surgical outcome by sealing the gap between the conjunctiva and Tenon capsule. The main challenge to successful surgical treatment of pterygium is recurrence, evidenced by fibrovascular growth across the limbus onto the cornea. Prevalence of pinguecula and pterygium in a general population in Spain. The condition is usually bilateral. Ophthalmology 1998;105:901904. Staging. A total of 32 eyes of 30 patients were managed at the Ocular Surface Center (Miami, Florida) from January 1, 2002, through December 31, 2010, with a minimum follow-up of 8 months, and subdivided into 3 groups. KheirkhahA, BlancoG, CasasV, TsengSC. Pterygium comes from the Greek word meaning wing, pterygos. 4 Ibechukwu BI. Liu J, Fu Y, Xu Y, Tseng SCG. Ma K, Xu L, Jie Y, Jonas JB. Written informed consent regarding the surgical procedures, alternatives, risks, and benefits was obtained from each patient. YamadaM, ShinodaK, HatakeyamaA, NishinaS, MashimaY. Definitive resolution may be more difficult to achieve than it is in adults, however, because pterygium recurs more aggressively and at a reportedly higher rate of 36.1% in children.4. Pterygium: a review of clinical features and surgical treatment. For 47.1(21.1) months, no recurrence was noted, 7 of 8 eyes with diplopia gained full motility, and 3 of 4 eyes with preoperative abnormal caruncles restored a C1 appearance (Figure 5A-D). From 2002 to 2004, the AS group (10 eyes) received thorough removal of fibrovascular tissue and AS to seal the gap. Gazzard G, Saw SM, Farook M, et al. B. Gelatinous. It is more common in the interpalpebral fissure area and may occur nasally or temporally or both. Ann Ophthalmol. We theorize that a gap is inevitably created between the conjunctiva and the Tenon capsule by bare sclera excision (Figure 1B and E). GaoY-Y, Di PascualeMA, LiW, Figure 2. The eyes were consecutively operated on by recession; sealing of the gap; covering of exposed medial rectus muscle by amniotic membrane, conjunctival autograft, or oral mucosal graft (OMG); and covering of the bare sclera with amniotic membrane. WebThe patient diagnosed as pterygium grade III + symblepharon + scaring cornea of left eye + senile immature cataract of both eye. The grading proposed by Tan et al1 is clinically useful for primary pterygia but was not suitable for recurrent pterygia because episcleral vessels were not visible in most of the 32 eyes (Figure 4). Alternatively, if there is not enough conjunctiva, then amniotic membrane transplant (AMT) may be glued or sutured into place (. ShimazakiJ, KosakaK, ShimmuraS, TsubotaK.Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium. New Grading System to Improve the Surgical Outcome of Multirecurrent Pterygia. Postoperatively, pain was missing in 27 patients (84%) but only mild on eye movement in the remaining 5 patients on the first day. Sunglasses that block 99%100% of both UVA and UVB rays are preferred. If the residual conjunctiva (RC) was missing, CA from the same eye or the fellow eye or oral mucosal graft (OMG) from the inferior labial oral cavity was harvested to attach to the sealed gap in the caruncle with a 8-0 Vicryl RS (Ethicon; Johnson & Johnson) and to the side of muscle belly with 2 interrupted 9-0 nylon sutures before further adhesion by FG underneath (Figure 3). Other complications include corneal scarring, corneal perforation, strabismus, nonhealing defect (especially with mitomycin C), scleral melt (especially with mitomycin C), and scleral dellen (. Low-dose intraoperative mitomycin C as chemoadjuvant for pterygium surgery. Healing time after pterygium surgery depends somewhat on how much tissue was removed, your personal health and healing ability, and Figure 1. The efficacy and safety of antivascular endothelial growth factor agents and cyclosporine have been postulated; however, their exact role in the treatment of the pterygium requires further studies. Keywords: adjuvant therapy, complications, pathophysiology, pterygium, surgical removal Afr Health Sci. The cap or leading edge is a flat zone on the cornea that consists mainly of fibroblasts that invade and destroy Bowmans membrane. Pinguecula. All operations were performed by the same surgeon (S.C.G.T.) ), Figure 4. Although UV irradiation plus genetic and environmental factors contribute to the development of pterygia, the exact underlying cause of pterygia remains largely elusive. To get started, you need only a few things: Are you a resident? SolomonA, PiresRTF, TsengSCG. Fluorescein dye improves microscopic evaluation and counting of Demodex in blepharitis with cylindrical dandruff. This video illustrates the PERFECT for pterygium technique. Epidemiologic study of pterygium in a Saharan population. Pseudopterygium. All Rights Reserved. Eze BI, Maduka-okafor FC, Okoye OI, Chuka-okosa CM. The lesion is not confined to the palpebral fissure. Your conjunctiva is the clear membrane that covers the white part of your eye. Br J Ophthalmol. 2012;12(2):21026. American Academy of Ophthalmology, 20102011). Prevalence and risk factors of pterygium in a southwestern island of Japan: the Kumejima Study. Accordingly, a grading system for recurrent pterygium was proposed with the purpose of predicting the success of surgical intervention. Views 2. 2023 American Medical Association. JUN 16, 2023 By Celia Vimont. The right eye had mild conjunctival hyperemia and a 23 mm temporal pterygium without involvement of the papillary area (Figure 10). Advantages include quicker epithelialization, minimal scarring and a resultant smooth corneal surface.1, Adjunctive therapies. 2015;2015:891582. Correspondence: Scheffer C. G. Tseng, MD, PhD, Ocular Surface Center and Ocular Surface Research & Education Foundation, 7000 SW 97th Ave, Ste 213, Miami, FL 33173 (stseng@ocularsurface.com). A pterygium (from the Greek, pterygos, little wing) is a wing-shaped, vascular, fleshy growth that originates on the conjunctiva and that can spread to the corneal limbus and beyond. PDF | Background: The aim of this study was to evaluate the efficacy of a deep learning system in pterygium grading and recurrence | Find, read and cite all the research you need on ResearchGate In patients with irritative symptoms, preservative-free artificial tears are recommended for mild inflammation and topical steroids are recommended for moderate inflammation. The AS was removed in 2 to 3 weeks. The recurrence rate is as high as 50% within 4 months and 97% recurrence rate within 12 months without autograft or amniotic membrane transplant (Hirst LW, 2003). Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. Amniotic membrane transplantation alone was successful in 23 eyes with residual conjunctiva of 27.8(10.1) mm, which was significantly longer than those in 6 cases in which amniotic membrane transplantation failed (13.1[11.4] mm, P=.007) and those in 8 cases in which amniotic membrane transplantation was successful but that required an additional conjunctival autograft or oral mucosal graft (10.9[10.4] mm, P=.001). (Tsai et al, 2002). By Susan Dsouza, MBBS, DOMS, and M. Gurudutt Kamath, MBBS, DOMS, MS, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC3561894/, International Society of Refractive Surgery, Astigmatism leading to visual impairment, a faculty advisor to review your manuscript and add his/her pearls from clinical experience. Regardless of the technique used, excision of the pterygium is the first step for repair. 2009;148(5):766771.e1. (Courtesy Dr. N. Nenkatesh Prajna. The diagnosis of pterygium isbased on the clinical appearance of the lesion. Typical findings include vascular straightening in the direction of the advancing head of the pterygium on the corneal surface. It may affect the nasal and temporal limbus of both eyes or only a single location. 2003;10(2):91-92. www.ncbi.nlm.nih.gov/pmc/articles/PMC3561894/. Such a gap is best demonstrated by two 0.12-mm forceps grabbing each tissue edge (E). WebA pterygium (from the Greek, pterygos, little wing) is a wing-shaped, vascular, fleshy growth that originates on the conjunctiva and that can spread to the corneal limbus and The opinions expressed represent the views of the individual participants, not the position of the Academy. Viso E, Gude F, Rodrguez-Ares MT. As the disease progresses, the lesion increases in size and becomes more apparent to the naked eye and may become cosmetically unpleasant for the patient. Pterygium: current concepts in pathogenesis and treatment. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, International Society of Refractive Surgery. Eye (Lond). Wu K, He M, Xu J, Li S.Pterygium in aged population in Doumen County, China. Figure 4. Customize your JAMA Network experience by selecting one or more topics from the list below. BarraquerJI. Persistent inflammation at 4.4(2.4) weeks was noted in the adjacent host conjunctiva or caruncle in 21 eyes (66%), among which 19 eyes (90%) received subconjunctival injections of triamcinolone acetonide, resulting in complete resolution in 16 eyes (84%). Preoperative (A and C) and postoperative (B and D) photographs show successful aesthetic appearance without G3 or G4 recurrence and caruncle restoration achieved by amniotic membrane transplantation alone in an eye with sufficient residual conjunctiva (RC) (27.3 mm) and a high residual to horizontal (RH) ratio (0.78) (A and B, patient 18) and in an eye without sufficient RC (6.3 mm) and a low RH ratio (0.17) (C and D, patient 11). All patients received photographic documentation of all preoperative and postoperative visits and digital recordings of their eyeball movement and surgical procedures. First, knowing RC could influence the surgical outcome, we recessed but did not resect the recurrent tissue. Most studies have shown a geographical variation in incidence, with countries closer to the equator showing higher rates of occurrence. The procedure is done in 3 logical segments: pterygium and extensive Tenon removal, retrieval of a very large and very thin graft, and finally the reconstruction of the Her family history is significant for diabetes. A pterygium larger than 3 mm may induce some astigmatism, and intervention may be warranted in such a case. Pterygium (pronounced tur-IJ-ee-um) is a raised, fleshy growth on your eyes conjunctiva. Shiratori CA, Barros JC, Loureno Rde M, Padovani CR, Cordeiro R, Schellini SA. Twelve-year outcomes of pterygium excision with conjunctival autograft versus intraoperative mitomycin c in double-head pterygium surgery. The 9-0 nylon RS was left intact because it was buried behind the caruncle. The prevalence of pterygium in Alkhobar: A hospital-based study. Submitted for Publication: December 22, 2010; final revision received April 10, 2011; accepted April 18, 2011. 2 Ang, L. P. et al. Clin Experiment Ophthalmol. Immediate postoperative photograph showing a suture conjunctival autograft after pterygium excision. 2015;63(6):491-495. 3 Stark, T. et al. 1 Krachmer, J. H. et al. WebAs a pterygium gradually encroaches toward the visual axis, it can cause astigmatism, which may be the main visual complaint. Cost of Surfers Eye (Pterygium) Surgery. Srinivasan S,Dollin M,McAllum P, Berger Y, Rootman DS, Slomovic AR. An incision separated the head from the peripheral corneal, limbal, and perilimbal bulbar sclera (Figure 2A), followed by dissection on the bare sclera plane to the superior and the inferior bulbar areas before separating the cicatrix from the rectus muscle surface (Figure 2B). High prevalence of Demodex in eyelashes with cylindrical dandruff. Increased levels of T-cells and inflammatory markers have also been noted in pterygial tissue compared to normal conjunctival tissue. Liu L, Wu J, Geng J, Yuan Z, Huang D. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. ), Figure 5. Recurrent pterygium. Turk J Med Sci. Compared with adults, children have an increased number of mast cells. Indian J Ophthalmol. WebBackground/aims To propose and validate a new pterygium grading system based on slit-lamp evaluation. See Image Library for figure. The glue is a blood-derived product and carries the risk (however minimal) of viral and prion disease. The clinical diagnosis of pterygium is based on history, anterior segment slit-lamp examination, and refraction to assess for astigmatism. MethodsA total of 32 eyes of 30 patients with pterygia were managed at the Ocular Surface Center from January 1, 2002, through December 31, 2010. A 9-0 nylon running suture (RS) is used to seal the gap in the RS group (G). The gap is invariably created when the pterygium head and body is removed (B). Binocular diplopia was noted in 26 eyes (81%) and graded as D1 in 16 eyes (62%), D2 in 8 eyes (31%), and D3 in 2 eyes (8%). The remaining 1 eye (patient 5) had no recurrence but was left with residual D2 diplopia only at adduction and a depressed hollow space in the nasal caruncle, causing dry eye and incomplete closure. Ophthalmology. As an important point of distinction, a probe can be passed beneath a pseudopterygium near the limbus, while this is impossible in true pterygium. Conjunctival and corneal intraepithelial neoplasm (CIN) (. Weckcel sponges (Medtronic Ophthalmics) soaked with 0.04% mitomycin C were inserted into the gap covering the entire forniceal region for durations indicated in Table 1 before being irrigated with half a bottle of balanced salt solution (Alcon Laboratories Inc). 2007;35(9):82833. Ultraviolet light exposure is thought to be the most likely cause, and dust, dryness, and wind are also risk factors. By continuing to use our site, or clicking "Continue," you are agreeing to our, Table 2. Previous studies have indicated that numerous risk factors are associated with pterygium, including UV radiation, 30, 31 environmental irritants such as dust and wind, 13 viral agents, 32, 33 familial and hereditary factors, 34 and immunological and inflammatory factors. 35, 36 Meseret A, Bejiga A, Ayalew M. Prevalence of pterygium in rural community of Meskan District, Southern Ethiopia. [Google Scholar] 31. Histologically, the subepithelial tissue shows senile elastosis (basophilic degeneration) of the substantia propria with abnormal collagen fibers. KheirkhahA, CasasV, ShehaH, RajuVK, TsengSCG. Friedberg M, Rapuano C. Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. To aid others who might use different cameras, we also measured the horizontal diameter of the fellow cornea at the primary gaze in the same manner as the reference for each patient (Figure 4F) and divided it by the RC to determine the residual to horizontal (RH) ratio. New York: Lippincott, Williams and Wilkins; 2008. Grading of caruncle morphological characteristics and residual conjunctiva (RC) and residual to horizontal (RH) ratio measurements. Mitomycin C was used in 7 eyes in the AS group, 6 eyes in the AS/FG group, and 1 eye in the RS group (ie, relatively more in the AS/FG group). PrabhasawatP, TesavibulN, LeelapatranuraK, PhonjanT.Efficacy of subconjunctival 5-fluorouracil and triamcinolone injection in impending recurrent pterygium. Fibrovascular tissue sandwiched between the conjunctiva (pink) and the Tenon capsule (green) flattens the caruncle (A, solid arrow) and anteriorly displaces the semilunar fold (A, broken arrow), causing recurrent pterygium (D). Kaufman S C, Jacobs D S, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Decrease in visual acuity due to astigmatism or encroachment onto visual axis, When it interferes with contact lens wear, Symptomatic degenerative changes like cystic changes. Pterygium pathophysiology. Br J Ophthalmol. A resident article published in the Ophthalmic Pearls section will satisfy the RRC requirements for resident scholarly activity. Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature. ( 2015 American Academy of Ophthalmology, www.aao.org. Pterygium is graded according to the extent of corneal involvement. 2011;20(1):714. From 2005 to 2008 when FG was available, the FG/AS group (13 eyes) received sealing of the gap by FG and AS without thorough removal of fibrovascular tissue. In contrast, for eyes without sufficient RC, conjunctival autograft (CA) (C and D) or oral mucosal graft (OMG) (E and F) is used. The recurrence rate is decreased to 5%10% with conjunctival flap/graft supplementation. Ultraviolet exposure (single most significant risk factor), Wedge-shaped, translucent membrane with apex extending onto cornea (, White to pink in color, depending on vascularity, Vascular straightening in the direction of the advancing head of the pterygium, Stocker line: iron line on cornea at leading edge of pterygium (, Degenerative changes such as cystic changes, Diagnosis is made clinically based on slit-lamp examination and typical appearance of the lesion (. Yan Ke Xue Bao.2002;18(3):1814. Because the recurrence rate was significantly higher in the AS/FG group, in which removal of fibrovascular tissue was not as thorough as in the AS group, we believe that mitomycin C alone is not sufficient to counteract recurrence, and an effective sealing (ie, thorough removal with AS or RS) may avoid mitomycin C use in recurrent pterygia. The only eye unsuccessfully treated (patient 5) had no RC after 9 prior operations, was left with D2 diplopia and C2 caruncle, and was enrolled in the RS group. The exposed muscle was covered by a small cryopreserved AM (AmnioGraft; Bio-Tissue) with the stromal surface facing down by FG. 3 Monga S et al. Typically, the growth progresses gradually and horizontally toward the limbus, cornea, and visual axis. Two eyes developed granuloma pyogenicum (6%), which resolved in 1 eye (patient 17) after frequent topical corticosteroid drops; 1 eye (patient 23) eventually progressed to corneal recurrence. At that time, use of ofloxacin was discontinued if epithelization was completed, whereas topical corticosteroid was tapered from 4 times a day for the next 4 weeks. It is usually seen as a triangular fleshy fibrovascular proliferation from the bulbar conjunctiva onto the cornea, located mostly on the nasal side. For pain, oral nonsteroidal anti-inflammatory drugs are given in pediatric doses according to body weight. Studies have shown that recurrence rates have dropped considerably with the addition of these therapies; however, they are not without their own complications.5. Sarac O, Toklu Y, Sahin M. The prevalence of pterygium in Ankara: a hospital-based study. For 24.7(13.6) months, 10 eyes had no recurrence, 9 eyes with preoperative diplopia achieved full ocular motility, and 6 of 11 eyes with abnormal caruncles restored a C1 appearance (Figure 6A-D). Pinguecula. MaDH, SeeLC, HwangYS, WangSF. Eye (Lond). Operations were uneventfully performed in all eyes. The histology is very similar to pterygium, and pingueculae often precede the development of pterygium. WebFibrovascular tissue sandwiched between the conjunctiva (pink) and the Tenon capsule (green) flattens the caruncle (A, solid arrow) and anteriorly displaces the semilunar fold (A, This condition appears as a yellow-white mound or aggregation of smaller mounds on the bulbar conjunctiva adjacent to the limbus, remaining localized to the conjunctiva without involving the cornea. Representative surgical outcome in the anchoring suture group. Medical treatment (artificial tears and lubricants) does not decrease progression or cause regression of pterygia. Our findings highlight the importance of the fibrovascular tissue emanating from the caruncle in contributing to pterygium growth and demonstrate the effectiveness of sealing the gap in combating pterygial recurrences. ), Figure 9. 2013;3(11):e003787. The study consisted of 32 eyes of 30 patients, including 18 men and 12 women, with a mean age of 52.2(12.4) years (range, 26-72 years). A meta-analysis of pooled data from 20 studies, encompassing more than 900,000 cases in 12 countries, found an overall prevalence of 10.2%, with a slightly higher rate among men than women.2. The caruncle grading was significantly correlated with severity of diplopia (P=.001), RC length (P=.01), and RH ratio (P=.01) (Table 2). In a linear regression, the extent of LPS was positively correlated with MMP-9 grades (r = 0.315, P = 0.026). (Courtesy Dr. N. Nenkatesh Prajna. A pterygium consists of three distinct parts: the cap, the head and the body/tail. There has been no consensus on the appropriate management of pterygia. KenyonKR, WagonerMD, HettingerME. Cornea, 2nd ed. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Patient-Reported Outcomes with LASIK Symptoms and Satisfaction, Pterygium excision with conjunctival autograft, Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature, Pattern of eye diseases among welders in a Nigeria community, The prevalence of pterygium in Alkhobar: A hospital-based study. A leading theory proposes that the increased prevalence of pterygium among people in equatorial regions is due to the damaging effects of ultraviolet radiation, specifically UV-B radiation. In the RS group, the gap was sealed by a 9-0 nylon RS (Ethicon; Johnson & Johnson) to encompass the entire fornix with or without AS (Figure 2G). Ghana Journal of Science. Caruncle grading, gap sealing improve treatment of recurrent pterygium. Ann Ophthalmol. This complication was the result of repeated removal of subconjunctival fibrovascular tissue (Figure 5E-H). Early in the disease process, pterygia are usually asymptomatic; however, there can be signs of dry eye (such as burning, itching or tearing) as the lesion causes irregular wetting of the ocular surface. Medical treatment for symptomatic children with small pterygia includes use of artificial tears and weak topical steroids to reduce inflammation and improve comfort. Br J Ophthalmol. The caruncle morphological characteristics were graded C1 in 11 eyes (34%), C2 in 9 eyes (28%), and C3 in 12 eyes (38%). ParisFdosS, de FariasCC, MeloGB, Dos SantosMS, BatistaJL, GomesJA. 4 Hirst, L. W. Ophthalmology 2008;115(10):16631672. San Francisco: American Academy of Ophthalmology; 2015. External photographs were taken at primary and extreme right and left gazes at 10 magnification under slitlamp examination using a Coolpix 5000 camera (Nikon Corp). 2003;48(2):14580. Shiroma H, Higa A, Sawaguchi S, et al. The recurrence rate is higher with fleshy, nontranslucent pterygia and increased postoperative inflammation. Small pterygia without visual impairment can be treated symptomatically with artificial tears and ocular lubricants. As a group, our surgical techniques reduced the recurrence rate to 3.1%, which was more favorable than the 20% to 73.7% reported using AM transplantation11,32 and the 7.3% to 42.8% reported using CA.911 Recurrent pterygia in our cases was more severe than that reported previously, including 2 studies reporting zero recurrence (Table 3). The anterior edge of the CA (C) or OMG (E) is sutured with a 8-0 Vicryl running suture to the conjunctival edge of the sealed gap, whereas the posterior edge is secured by 2 interrupted 10-0 nylon sutures (D); the graft can then be further secured to the muscle surface by fibrin glue smoothened by a muscle hook (F). J Family Community Med. There is a lack of consensus in the ophthalmological community about the optimal medical and surgical management of pterygia. This finding explained why additional CA or OMG was necessary and achieved 100% success in 8 eyes with a short RC of 10.9(10.4) mm, which was also significantly less than those eyes successfully treated by AM transplantation alone (P=.001). Todani A, Melki SA. (Reproduced from Garcia-Medina JJ et al. Double-head recurrent pterygia was noted in 4 eyes of 3 patients (12%), with 1 patient having pterygia in both eyes. The RC for those 23 patients successfully treated with AM transplantation alone was 27.8(10.1) mm, which was significantly longer than for those 6 patients unsuccessfully treated with AM transplantation alone (13.1[11.4] mm, P=.007) and those 8 successfully treated eyes that required additional CA or OMG (10.9[10.4] mm, P=.001). (Philadelphia: Elsevier Mosby, 2005), 1481. Hence, failure of sealing such a gap may lead to recurrence. Pterygium in Indonesia: prevalence, severity and risk factors.Br J Ophthalmol. Children who have had pterygium excision should be examined every month for 6 months and, subsequently, once every 6 months. All data were reported as mean (SD) and analyzed using SPSS statistical software, version 17.0 (SPSS Inc). 2011;25(3):3507. The remaining 5 eyes, including 4 eyes unsuccessfully treated as previously mentioned (patient 5 from the AS group, patients 21 and 22 from the FG/AS group, and patient 28 from the RS group), had short RC from 0 to 13.5 mm and received CA. Literature Summary of Recurrent Pterygium Studies. In children with a primary pterygium, conjunctival autograft is the treatment of choice.5 Conjunctival rotational autograft can be considered, with the caveat that in some active children, constant eye movement may displace the graft. Many surgical techniques have been used, though none is universally accepted because of variable recurrence rates. Pattern of eye diseases among welders in a Nigeria community. Without sufficient RC, epithelial healing came only from superior and inferior fornices, and delayed epithelization might lead to persistent inflammation and scarring, triggering recurrence when the gap is not sealed. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. One eye (patient 28) with RC of 6.3 mm had G4 recurrence, D2 diplopia, and C3 caruncle (Figure 7C and D). 2010;73(4):3435. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Rojas JR, Mlaga H. Pterygium in Lima, Peru. ), Figure 2. If scleral dellen are present, aggressive lubrication with artificial tear ointment every 2 hours. Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: recurrence rate and cosmesis. Cajucom-Uy H, Tong L, Wong TY, et al. Polymorphisms of the DNA break repair gene Ku70 have been associated with genetic predisposition to pterygia development. Int Ophthalmol Clin. The corneal (G4) recurrence rates vary from 0% to 82.4% in all reported studies of recurrent pterygia (Table 3). Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature. That was why RS was used to seal the gap and found to be effective in restoring a normal caruncle because of the natural tendency of the Tenon capsule to retract posteriorly (Figure 1C and F).