Clinical Research on Surgical Treatment for Double-Head Pterygium

Byeong Hee Lee; Gwang Ja Lee; Young Jeung Park; Kyoo Won Lee

doi:10.3341/jkos.2010.51.5.642

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Lee, Lee, Park, and Lee: Clinical Research on Surgical Treatment for Double-Head Pterygium

Original Article

J Korean Ophthalmol Soc 2010;51(5):642-650.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.5.642

Clinical Research on Surgical Treatment for Double-Head Pterygium

Byeong Hee Lee, MD, Gwang Ja Lee, MD, Young Jeung Park, MD, Kyoo Won Lee, MD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD Cheil Eye Hospital #803-2 Sinam-dong, Dong-gu, Daegu 701-011, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eyepark9@dreamwiz.com

Received 9 November 2009 Accepted 4 February 2010

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 evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate.

Methods

In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications.

Results

Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.9±3.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.2±1.8 months. Within the split-conjunctival grafts group, the mean fol-low-up was 13.6±2.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site.

Conclusions

In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.

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Keywords: Amniotic membrane transplantation, Double-head pterygium, Split-conjunctival grafts

References

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Figure 1.

Surgical procedure of split-conjunctival grafts for double-head pterygium. (A) The temporal and nasal side pterygium is along with adjacent fibrovascular tissue. (B, C) Conjunctival graft (6 mm) is dissected from the fornix leaving the underlying Tenon's capsule intact, flipped over the cornea. (D, E) From the donor conjunctiva, the distal 3 mm is excised and attached to the temporal bare sclera area using tissue adhesives. (F, G, H) The remaining graft is excised all the way down to the limbus, and attached to the nasal bare sclera area using tissue adhesives. (I) To protect and stabilize the conjunctiva autograft, temporary amniotic membrane transplantation is applied onto the whole eye with 10–0 nylon suture left in place for 5∼7 days.

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Figure 2.

Pre and postoperative photographs for amniotic membrane transplantation group. (A, B1) Preoperative photograghs of double-head pterygium. (A, B2) The transplanted amniotic membrane seems to blend in with stable ocular surface at 3 months postoperatively. (A3) Conjunctival recurrence at 5 months postoperatively. (B3, B4) Shows corneal recurrence at 9 months postoperatively, and the following stabilization after limbal-conjunctival autograft.

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Figure 3.

Pre and postoperative photogragh for split-conjunctival grafts group. (A, B1) Preoperative photograghs of double-head pterygium. (A, B2) Well-positioned graft and quiet conjunctival surface are observed in subjects at 1 month postoperatively. (A, B3) Normal appearance is seen and recurrence of pterygium is not recognized in subjects at 12 months postoperatively.

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Table 1.

Demographic data of patients in the two study groups

	AMT^*	Split-conjunctival graft
Number of eyes (patients)	7 (6)	9 (8)
Primary / Recurrent (eyes)	5 / 2	7 / 2
Age (years) (range)	60.1±7.9 (48∼72)	59.0±9.9 (44∼78)
Gender (Male:Female)	4: 3	3: 6
Follow-up (months) (range)	21.9±3.5 (18∼27)	13.6±2.1 (12∼18)

^* AMT=amniotic membrane transplantation.

Table 2.

Summary of surgical results within amniotic membrane transplantation group

Case	Age/Sex	Primary/	Follow-up	VA^* change	Corneal astigmatism change
		Recurrent	(months)		(Diopter)
1	48/M	Primary	24	0.7 → 1.0	0.5 → 0.25
2	66/M	Primary	18	0.15 → 0.5	4 → 0.75
3	72/M	Recurrent	27	0.06 → 0.2	13.25 → 4.25
4	61/F	Primary	19	0.4 → 0.4	Error → 3
5	61/F	Recurrent	18	0.06 → 0.4	Error → 6.25
6	60/F	Primary	24	0.7 → 0.8	0.75 → 1.0
7	53/M	Primary	23	0.9 → 0.9	6.25 → 0.5

^* VA=visual acuity.

Table 3.

Summary of surgical results within split-conjunctival grafts group

Case	Age/Sex	Primary/	Follow-up	VA^* change Co	orneal astigmatism change
		Recurrent	(months)		(diopter)
1	44/F	Primary	13	0.7 → 1.0	1 → 0.5
2	55/F	Primary	18	0.3 → 0.5	11.5 → 0.5
3	60/M	Primary	12	0.8 → 0.7	Error → 1.25
4	55/F	Primary	15	0.3 → 0.7	Error → 3.25
5	61/F	Primary	13	0.5 → 0.5	1 → 0.5
6	65/F	Recurrent	15	0.6 → 0.9	0.75 → 0.75
7	54/F	Recurrent	12	0.8 → 1.0	0.75 → 1
8	78/M	Primary	12	0.06 → 0.4	Error → 1.75
9	78/M	Primary	12	0.06 → 0.2	11.25 → 1

^*VA=visual acuity.

Table 4.

Recurrence and complications of the two study groups

	AMT^*	Split-conjunctival graft
G2 (conjunctival recurrence)	3/7 (43%)	0/9 (0%)
G3 (corneal recurrence)	2/7 (29%)	0/9 (0%)
Location of recurrence	Nasal: 5/5 (100%)	·
Mean recurrent period (months) (range)	7.2±1.8 (5∼9)	·
Complication
Vascularization at donor site^†	0	1
Subgraft hemorrhage	2	2

^* AMT=amniotic membrane transplantation

^† Excessive fibrovascular tissue proliferation at donor site (similar to pseudopterygium).

Table 5.

Previous reports on surgical treatment for double-head pterygium

Author(s)	Pterygium	Number	Surgery technique	Mean follow-up	Recurrence
	type	of eyes		(months)	rate^‡ (%)
Solomon et al⁶	Primary	11	Extensive pterygium excision with AMT^†	12.8±4.3	1/11 (9%)
Avisar et al⁷	Primary	10	Bare sclera technique with	36.3±3.8	0/10 (0%)
	Recurrent	3	0.02% MMC^* (5 minutes)	28.4±2.7	1/3 (33%)
Maheshwari et al⁸	Primary	7	Split-conjunctival graft	17.7±6.0	0/7 (0%)
Wu et al⁹	Primary	20	Conjunctival rotational autograft combined	22.6	7/20 (35%)
			with conjunctival autograft

^* MMC=mitomycin C

^† AMT=amniotic membrane transplantation

^‡ Recurrence rate is defined as fibrovascular tissue invading the cornea.

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