Journal List > J Korean Ophthalmol Soc > v.53(10) > 1009190

Park, Han, and Seo: Recurrence after Modified Mini-Flap Technique for Pterygium Surgery

Abstract

Purpose

To compare and analyze the clinical outcomes after the traditional mini-flap technique and a new modified mini-flap technique for pterygium surgery.

Methods

This is a retrospective, clinical outcome study of 39 eyes that received the existing mini-flap technique from January, 2004 to August, 2005, and 142 eyes that received the modified mini-flap technique from September, 2008 to December, 2010. We analyzed the recurrence rate of each mini-flap technique and the difference between the group that experienced recurrence and the group that did not. We also analyzed the difference between the group that received the mini-flap technique and the group that received the modified mini-flap technique.

Results

The recurrence rate of pterygium patients who received the mini-flap technique was 10.3% (4/39). The rate of those who received the modified mini-flap technique was 2.1% (3/142), which is statistically lower (p = 0.040). However, compared from the recurrence rate of 6.1% (3/49) that was reported in 2008, the recurrence rate of the modified mini-flap technique did not show any statistical significance (p = 0.165). From the comparison of demographic factors of the patients in each surgical technique group, in both recurred and not recurred group, the patient group in the modified mini-flap technique group whose pterygium was recurrd was the youngest (p < 0.001).

Conclusions

The newly applied modified mini-flap technique is not only a safe method with low recurrence rate compared to the traditional mini-flap technique, but also a reliable surgical technique in both primary and recurred pterygium.

Figures and Tables

Figure 1
Mini-flap technique. (A) Create conjunctival window on pterygium neck, (B) remove pterygium from head to body, (C) conjunctival relaxing incision for preparing a conjunctival flap, (D) limbal margin conjunctiva-sclera-conjunctiva and several conjunctiva-conjunctiva sutures, (E) another limbal margin conjunctival-sclera-conjunctiva suture.
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Figure 2
Modified mini-flap technique. (A) Create conjunctival window on pterygium neck, (B) remove pterygium from head to body, (C) conjunctival relaxing incision above or below the limbus for preparing a flap, (D) two conjunctiva-sclera-conjunctiva sutures at corneolimbal margin and innermost part of a conjunctival flap (black-arrow), (E) another limbal margin conjunctiva-sclera-conjunctiva suture.
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Figure 3
Cumulative proportion without recurrence of pterygium after surgery (Kaplan-Meier survival curves).
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Figure 4
(A, C) Postoperative 1 day in patients received modified mini-flap technique (B, D) Postoperative 1 month in patients received modifiec mini-flap technique.
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Table 1
Demographic characteristics of patients and recurrence rate
jkos-53-1419-i001

*t-test; χ2 test.

Table 2
Difference between recurrence and nonrecurrence cases in the mini-flap group
jkos-53-1419-i002

NA = non-available.

*t-test; χ2 test.

Table 3
Difference between recurrence and nonrecurrence cases in the modified mini-flap group
jkos-53-1419-i003

NA = non-available.

*t-test; χ2 test.

References

1. Sebban A, Hirst LW. Pterygium recurrence rate at the Princess Alexandra Hospital. Aust N Z J Ophthalmol. 1991. 19:203–206.
2. Youngson RM. Recurrence of pterygium after excision. Br J Ophthalmol. 1972. 56:120–125.
3. Cardillo JA, Alves MR, Ambrosio LE, et al. Single intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery. Ophthalmology. 1995. 102:1949–1952.
4. Frucht-Pery J, Ilsar M, Hemo I. Single dosage of mitomycin C for prevention of recurrent pterygium: preliminary report. Cornea. 1994. 13:411–413.
5. Young AL, Leung GY, Wong AK, et al. A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol. 2004. 88:995–997.
6. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985. 92:1461–1470.
7. Chen PP, Ariyasu RG, Kaza V, et al. A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol. 1995. 120:151–160.
8. Lewallen S. A randomized trial of conjunctival autografting for pterygium in the tropics. Ophthalmology. 1989. 96:1612–1614.
9. Wong VA, Law FC. Use of mitomycin C with conjunctival autograft in pterygium surgery in Asian-Canadians. Ophthalmology. 1999. 106:1512–1515.
10. Bekibele CO, Ashaye A, Olusanya B, et al. 5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence. Int Ophthalmol. 2012. 32:3–8.
11. Akura J, Kaneda S, Matsuura K, et al. Measures for preventing recurrence after pterygium surgery. Cornea. 2001. 20:703–707.
12. Cano-Parra J, Diaz-Llopis M, Maldonado MJ, et al. Prospective trial of intraoperative mitomycin C in the treatment of primary pterygium. Br J Ophthalmol. 1995. 79:439–441.
13. Panda A, Das GK, Tuli SW, Kumar A. Randomized trial of intraoperative mitomycin C in surgery for pterygium. Am J Ophthalmol. 1998. 125:59–63.
14. Lam DS, Wong AK, Fan DS, et al. Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow-up study. Ophthalmology. 1998. 105:901–904.
15. Dougherty PJ, Hardten DR, Lindstrom RL. Corneoscleral melt after pterygium surgery using a single intraoperative application of mitomycin-C. Cornea. 1996. 15:537–540.
16. Kheirkhah A, Izadi A, Kiarudi MY, et al. Effects of mitomycin C on corneal endothelial cell counts in pterygium surgery: role of application location. Am J Ophthalmol. 2011. 151:488–493.
17. Kim M, Chung SH, Lee JH, et al. Comparison of mini-flap technique and conjunctival autograft transplantation without mitomycin C in primary and recurrent pterygium. Ophthalmologica. 2008. 222:265–271.
18. Eze BI, Maduka-okafor FC, Okoye OI, Chuka-okosa CM. Pterygium: A review of clinical features and surgical treatment. Niger J Med. 2011. 20:7–14.
19. Jaros PA, DeLuise VP. Pingueculae and pterygia. Surv Ophthalmol. 1988. 33:41–49.
20. Yamazoe K, Shimazaki-Den S, Otaka I, et al. Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft. Clin Ophthalmol. 2011. 5:1609–1611.
21. Thakur SK, Khaini KR, Panda A. Role of low dose mitomycin C in pterygium surgery. Nepal J Ophthalmol. 2012. 4:203–205.
22. Kheirkhah A, Hashemi H, Adelpour M, et al. Randomized trial of pterygium surgery with mitomycin C application using conjunctival autograft versus conjunctival-limbal autograft. Ophthalmology. 2012. 119:227–232.
23. Mandour SS, Farahat HG, Mohamed HM. Preoperative subpterygial mitomycin C injection versus limbal conjunctival autograft transplantation for prevention of pterygium recurrence. J Ocul Pharmacol Ther. 2011. 27:481–485.
24. Shenoy R, Bialasiewicz AA, Al-Barwani B. Late corneal thinning and keratitis following mitomycin-C use in pterygium surgery. Sultan Qaboos Univ Med J. 2011. 11:286–287.
25. Li M, Zhu M, Yu Y, et al. Comparison of conjunctival autograft transplantation and amniotic membrane transplantation for pterygium: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2012. 250:375–381.
26. Jap A, Chan C, Lim L, Tan DT. Conjunctival rotation autograft for pterygium. An alternative to conjunctival autografting. Ophthalmology. 1999. 106:67–71.
27. Dadeya S, Malik KP, Gullian BP. Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft. Ophthalmic Surg Lasers. 2002. 33:269–274.
28. Alp BN, Yanyali A, Ay GM, Keskin O. Conjunctival rotation autograft for primary pterygium. Ophthalmologica. 2002. 216:333–336.
29. Gopwani R, Cheng L, Tang W, Lam DS. Surgical technique for recurrent pterygium. Ophthalmology. 2006. 113:1469–1470. author reply 12470.
30. Chang YS, Chen WC, Tseng SH, et al. Subconjunctival mitomycin C before pterygium excision: an ultrastructural study. Cornea. 2008. 27:471–475.
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