Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

Chang Hyun Kim; Jin Kee Lee; Dae Jin Park

doi:10.3341/jkos.2009.50.12.1780

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Kim, Lee, and Park: Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

Original Article

J Korean Ophthalmol Soc 2009;50(12):1780-1788.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1780

Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

Chang Hyun Kim, MD, Jin Kee Lee, MD, Dae Jin Park, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Dae Jin Park, MD, Department of Ophthalmology, Daegu Fatima Hospital #576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel: 82-53-940-7140, Fax: 82-53-954-7417, E-mail: djoph2540@yahoo.co.kr

Received 1 June 2009 Accepted 8 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium.

Methods

Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively.

Results

With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups.

Conclusions

Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.

Keywords: Amniotic membrane transplantation, Conjunctival autograft, Conjunctivolimbal autograft, Pterygium, Recurrence rates

References

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Figure 1.

Classification of pterygium. (A) Grade T1 (atrophic), episcleral vessels are unobscured. (B) Grade T2 (intermediate), episcleral vessels are partially obscured. (C) Grade T3 (fleshy), episcleral vessels are totally obscured.

Figure 2.

Grading of recurrence after pterygium surgery. (A) Grade 0, normal appearance of the operated site. (B) Grade 1, fine episcleral vessels in the excised area. (C) Grade 2, fibrovascular tissue in the excised area, reaching to the limbus, but not invading the cornea (conjunctival recurrence). (D) Grade 3, fibrovascular tissue invading the cornea (corneal recurrence).

Figure 3.

Complications after pterygium surgery. (A) Sub-AM hemorrhage. (B) Sub-conjunctival graft hemorrhage. (C) Dornor site scarring. (D) Granuloma. (E) Dornor site limbal stem cell deficiency. (F) Wound gaping (yellow star).

Table 1.

Demographic data among amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft group, and conjunctivolimbal autograft group

	AMT^* with FG^§(33 eyes)	AMT^* with suture (29 eyes)	CAU^†(28 eyes)	CLAU^‡(31 eyes)	p-value
Age (years) (Mean± SD^Π)	62.6±12.4	54.3±12.1	60.1±10.8	56.7±10.1	0.228^#
Sex (Male:Female)	13:18	9:18	10:16	8:22	0.714^**
Follow-up (months)	22.2±8.0	18.4±4.8	22.7±7.2	21.8±7.2	0.631^#
(Mean± SD^Π)
Grade T₂:T₃	9:24	11:18	11:17	10:21	0.801^**

^* AMT=amniotic membrane transplantation

^† CAU=conventional conjunctival autograft

^‡ CLAU=conjunctivolimbal autograft

^§ FG= fibrin glue

^Π SD=standard deviation

^# Measured by chi-square test

^** Measured by student's t-test.

Table 2.

Comparison of recurrence rates according to the surgical method

	AMT^* with FG^§	AMT^* with suture	CAU^†	CLAU^‡	p-value
	(33 eyes)	(29 eyes)	(28 eyes)	(31 eyes)
G₀	21 (63.6%)	12 (41.4%)	28 (100%)	31 (100%)
G₁	4 (12.1%)	8 (27.6%)	0	0
G₂^Π	7 (21.2%)	6 (20.7%)	0	0	0.003^**
G₃^#	1 (3.0%)	3 (10.3%)	0	0	0.089^**
Total (G₂^Π+G₃^#) recurrence rates	8/33 (24.2%)	9/29 (31.0%)	0/28 (0%)	0/31 (0%)	<0.001^**

^* AMT=amniotic membrane transplantation

^† CAU=conventional conjunctival autograft

^‡ CLAU=conjunctivolimbal autograft

^§ FG =fibrin glue

^Π G₂=conjunctival recurrence

^# G₃=corneal recurrence

^** Measured by chi-square test.

Table 3.

Complications among amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft group, and conjunctivolimbal autograft group

	AMT^* with FG^§	AMT^* with suture	CAU^†	CLAU^‡
	(33 eyes)	(29 eyes)	(28 eyes)	(31 eyes)
Sub-AM^Π hemorrhage	5 (15.1%)	7 (24.1%)	⋅	⋅
Delayed epithelial healing	1 (3.0%)	0	0	0
Pyogenic granuloma	2 (6.1%)	4 (13.7%)	0	0
Wound gapping	0	1 (3.4%)	1 (3.6%)	2 (6.4%)
Sub-graft hemorrhage	⋅	⋅	6 (21.4%)	7 (22.6%)
Scarring of donor site	⋅	⋅	1 (3.6%)	0
Focal LSCD^# at donor site	⋅	⋅	⋅	1 (3.2%)

^* AMT=amniotic membrane transplantation

^† CAU=conventional conjunctival autograft

^‡ CLAU=conjunctivolimbal autograft

^§ FG =fibrin glue

^Π AM=amniotic membrane

^# LSCD=limbal stem cell deficiency.

Table 4.

Recurrence rates after different methods of pterygium surgery

Reference	Surgery Co	orneal recurrence rates (%(Primary/Recurrent)	) Number of eyes
Tan et al, 1997⁴	CAU^† with bare sclera+ dexamethasone	2.0/0	61
Al Fayea MF, 2002⁵	CAU^†	8.3/33.3	79
	CLAU^‡	0/0
Solomon et al, 2001⁹	AMT^*+triamcinolone	3.0/9.5	54
Prabhasawat et al, 1997¹¹	AMT^*	10.9/37.5	176
	CAU^†	2.6/9.1
Kwak et al, 2008¹⁸	CLAU^‡+triamcinolone	0/0^§	39
Kenyon et al, 1985²²	CAU^†	5.3	57
Jang and Choi, 2005²⁴	AMT^* with bare sclera	9.0/6.0	28
Ti et al, 2000²⁵	CAU^†	20.8/31.2	203

^* AMT=amniotic membrane transplantation

^† CAU=conventional conjunctival autograft

^‡ CLAU=conjunctivolimbal autograft

^§ Conjunctival recurrence rates was noted in 5.6%.

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