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Abstract
Purpose
To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft.
Methods
The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C.
Results
Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C.
References
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Figure 1.
The Kaplan-Meier survival curves of pterygium recurrence after surgery. (A) Pterygium excision with conjunctival autograft vs. pterygium excision without conjunctival autograft. The recurrence rate of pterygium was significantly lower in conjunctival autograft group (p = 0.024, Breslow-Wilcoxon test). (B) Pterygium excision with conjunctival autograft vs. pterygium excision with amniotic membrane transplantation (AMT). The recurrence rate of pterygium was significantly lower in conjunctival autograft group, compared to amniotic membrane transplantation group (p = 0.028, Breslow-Wilcoxon test). (C) Pterygium excision with conjunctival autograft vs. pterygium excision with conjunctival flap. (D) Pterygium excision with conjunctival autograft vs. pterygium excision with simple conjunctival closure. There are no significant differences in the recurrence between conjunctival autograft group and conjunctival flap or simple closure group.
Figure 2.
The Kaplan-Meier survival curve of pterygium recurrence after pterygium excision with conjunctival autograft according to the intraoperative use of mitomycin C. One eye recurred in 10 eyes (10.0%) with pterygium surgery using mitomycin C intraoperatively, while two of 119 eyes (1.7%) without the use of mitomycin C recurred. The difference is not statistically significant. MMC = mitomycin C.
Figure 3.
Anterior segment photographs of patients that developed recurrence after primary pterygium excision with conjunctival autograft. The preoperative and postoperative photographs of three eyes whose pterygium recurred after pterygium excision with conjunctival autograft showed that recurred pterygia were milder in size, vascularization, and fleshiness, compared to those before excision. Patient 1 had recurrence at the postoperative 6 months, patient 2 at the postoperative 49 months, and patient 3 at the postoperative 4 months.
Table 1.
Patient demographics and clinical characteristics
Table 2.
Comparison between conjunctival autografts with and without intraoperative mitomycin C
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