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Abstract
Purpose
To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium.
Methods
Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated.
Results
In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 ± 0.08. T3 of Tan's preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02).
Conclusions
The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.
Figures and Tables
Figure 1
Preoperative grades for primary pterygium before surgery. T1 (atrophic pterygium): Episcleral vessels unobscured. T2 (intermediate pterygium): Episcleral vessels partially obscured. T3 (fleshy pterygium): Episcleral vessels totally obscured.
Figure 2
Postoperative grades after excision of primary pterygium. G0 (grade 0) indicates a normal appearance of the operated site. G1 (grade 1) indicates the presence of some fine episcleral vessels, but without any fibrous tissue in the excised area extending up to but not beyond the limbus. G2 (grade 2, conjunctival recurrence) indicates the presence of additional fibrous tissues in the excised area without invading the cornea. G3 (grade 3, corneal recurrence) represents a true recurrence with a fibrovascular tissue invading the cornea.
Figure 3
Pterygium size on M-view system with a mathematical formula of quadrangle. (A) Vp = vertical distance (pixel); Hp = horizontal distance (pixel); θ = angle between V & H; D = corneal diameter (mm). (B) A mathematical formula of quadrangle.
Figure 4
Surgical procedures of pterygium excision and temporary amniotic membrane patch. (A) The pterygium body and head is undermined and removed by blunt dissection. (B) The corneal defect area is shaved of any residual tissue with a Beaver blade and a diamond burr. (C) At the end of tissue excision, the amniotic membrane is removed from the filter paper, and placed over the conjunctival defect with the basement membrane side down. And the amniotic membrane is secured to the episclera and the excision edges of the normal conjunctiva with a continuous 10-0 nylon suture.
Figure 5
Incidence of each postoperative pterygium grades based on the preoperative pterygium grades. No postoperative recurrence was observed in preoperative T1 group. But, there were clinically significant G2 and G3 recurrence-occurred eyes in T2 and T3 groups; 2 eyes (4.8%; 2/42 eyes) of G3 recurrence were observed in T2 group; 4 eyes (13.8%; 4/29 eyes) of G2 recurrence were observed in T3 group.
Figure 6
Kaplan-Meier survival analysis showing the cumulative proportion without recurrence following the temporary amniotic membrane patch with the excision of primary pterygium. This survival curve indicates that the estimated recurrence-free (G0 & G1) rate at postoperative 24 months is 0.83 ± 0.08.
Table 5
Risk factors influencing a recurrence of pterygium after surgery in relation to preoperative parameter
Table 6
Recurrence rates of amniotic membrane transplantation after excision of primary pterygium in recent reports
AMT = amniotic membrane transplantation; BM = basement membrane.
*Final appearance was graded according to the grading system (G0 to G3) reported by Prabhasawat et al,9 and overall recurrence rate was defined as G2 and G3; †Intraoperatively, local triamcinolone acetonide injections (10 to 16 mg in total) were given along the edges of the excised conjunctiva at the end of tissue excision; ‡The recurrence rate of the study was evaluated at postoperative 6 months.
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