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Abstract
Purpose
To investigate the clinical effect of micro-multiporous e-PTFE insertion for severe recurrent pterygium with symblepharon.
Methods
The present study included a total of 13 cases of recurrent pterygium associated with symblepharon, motility restriction and diplopia which had undergone micro-multiporous e-PTFE insertion after pterygium excision, 0.02% mitomycin C application, human amniotic membrane transplantation (AMT) and/or conjunctivo-limbal autograft (CLAU) between September 2010 and February 2011. One month after surgery, the inserted e-PTFE was removed. Recurrence of pterygium and symblepharon, motility restriction, diplopia and injection of ocular surface were evaluated for 11.92 ± 1.32 months of mean follow-up period.
Results
Pterygial recurrence was not observed in 12 out of 13 eyes, and the 1 eye which recurred showed conjunctival recurrence. No postoperative symblepharon recurrence was observed in any of the 13 eyes. Diplopia and motility restriction disappeared in 11 out of 13 eyes, and were improved in the other 2 eyes. VAS (Visual Analogue Scale) injection scores in the wound site decreased after surgery in all patients.
References
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Figure 1.
(A) Diagrammatic representation of patient with recurrent pterygium, preoperative (A1) and postoperative (A2). (A2) M icro-multiporous e-PTFE is inserted and well-fitted with the gap sealed between the conjunctiva and post-excised pterygium wound site. Note that there is no micropore on e-PTFE, especially under the buried site (arrows) to prevent fibrovascular tissue from growing through. (B, C) E-PTFE is inserted under the remained nasal conjunctiva, with micopores only at the area exposed to air.
Figure 2.
Postoperative appearances of epithelialization after fluorescein staining (Case 7). (A, B) At 2 weeks after the surgery, epithelization is observed on exposed permanent AM graft site (arrows). (C, D) Epithelization is observed when e-PTFE is removed 1 month after the surgery at the previously multiporous e-PTFE-implanted site (arrows).
Figure 3.
Preoperative and postoperative appearances of case 1 (A), case 2 (B), case 3 (C), case 6 (D). Preoperatively, symblepharon of the eyelid and the nasal caruncle adhered to the cornea are noted (A1-D1). M icro-multiporous e-PTFE was removed 1 month after the surgery (A2, B2: just before removal; C2, D2: just after removal). Postoperatively, fibrovascular tissue was completely removed, and recurrence was not noted 12 months after the surgery (A3-D3).
Figure 4.
Postoperative pterygial recurrence case (Case 8). (C) Severe injection is noted at the pterygium-excised site 1 month after the surgery. (D) Fibrovascular tissue adhesion is noted (arrows) limited to the excised area, not adjacent to the limbus.
Table 1.
Summary of clinical data
Table 2.
Clinical grading system for pterygium morphology
Table 3.
Clinical grading system for pterygium recurrence
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