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Comparison of Wide Conjunctival Flap and Conjunctival Autografting Techniques in Pterygium Surgery  [PDF]
Lokman Aslan,Murat Aslankurt,Adnan Aksoy,Murat ?zdemir,Erdem Yüksel
Journal of Ophthalmology , 2013, DOI: 10.1155/2013/209401
Abstract: Pterygium is an abnormal fibrovascular tissue extending on the cornea which is a degenerative and hyperplastic disorder. A stromal overgrowth of fibroblast and blood vessels is accompanied by an inflammatory cell infiltrate and abnormal extracellular matrix accumulation. The surgical excision is the main treatment method of pterygium, but recurrence is the most common postoperative complication. In the present study, we aimed to compare the wide conjunctival flap and the conjunctival autografting techniques in pterygium surgery according to time of operation, safety, and effectiveness. Results showed that the effect of wide conjunctival flap techniques on primary pterygium surgery was found close to the conjunctival autograft techniques. In addition, the flap technique has a shorter surgical time, the surgery does not require extreme experience, feeding of the flap is provided with own vessels since the vascular structure is protected on the upper temporal conjunctival area, reverse placement of the flap is not seen, it needs fewer sutures, so that suture disturbances may reduce, and it is less traumatic than autograft technique during conjunctival transport. Therefore, this technique may be preferred in suitable cases. 1. Introduction Pterygium is an abnormal fibrovascular tissue extending on the cornea which is a degenerative and hyper plastic disorder [1]. A stromal overgrowth of fibroblast and blood vessels is accompanied by an inflammatory cell infiltrate and abnormal extracellular matrix accumulation [2]. Recently authors have focused on ultraviolet rays whether it could be any changes in limbal stem cell [3]. Although several hypotheses have been associated with etiology, its pathology still remains to be explained [4]. Some individuals or occupational groups are susceptible to this disease. It is more common in drivers, welders, and carpenters, the countries with relatively high exposure to ultraviolet radiation, the hot and dusty climates, and those living in rural areas [3, 4]. While the body of the pterygium remains on the sclera, the head advances onto the cornea in many cases affecting vision, causing general discomfort, and becoming a cosmetic nuisance [5]. The surgical excision is the main treatment method of pterygium. The various surgical techniques such as bare sclera, conjunctival autografting, primary conjunctival closure, intraoperative mitomycin C application, and amniotic membrane transplantation have been applied [6, 7]. Recurrence is the most common postoperative complication [8]. Although many techniques have been tried in
The Choice of Pterygium Surgery Tactics  [PDF]
О.Ya. Buchko,Т.А. Tsyganova,М.М. Shishkin
Sovremennye Tehnologii v Medicine , 2011,
Abstract: The aim of the investigation is to state the main aspects responsible for the choice of pterygium surgery tactics. Materials and Methods. There were studied the patients operated on according to limbal auto- and allotransplantation. Control group consisted of patients operated on according to Mc Reynolds technique.Conclusion. Limbal auto- and allotransplantation should to be used in recurrences of pterygium, in extensive bilateral pterygium, and in severe associated systemic diseases.
Results of conjunctival autograft in pterygium surgery in Lumbini Eye Instititue, Nepal  [PDF]
K Dhakhwa,S Patel,MK Sharma,SKC Rai,AM Bhari
Journal of Universal College of Medical Sciences , 2014, DOI: 10.3126/jucms.v2i1.10482
Abstract: BACKGROUND: A pterygium is a wedge shaped fibrovascular growth of conjunctiva that extends onto the cornea. Various surgical techniques are used to treat this condition. Conjunctival graft over the bare sclera is one of the techniques used. The present study was done to evaluate the efficacy of autologous conjunctival graft in surgical management of primary and recurrent pterygium. MATERIALS AND METHODS: All the patients who underwent conjunctival autograft surgery for primary and recurrentpterygium from 1st Jan. 2010 to 30th June 2010 were enrolled prospectively. Follow up was done for six months after the surgery. RESULTS: A total of240 patients operated for primary and recurrent pterygium were enrolled in this study. There were 107 (44.6%) male and 133 (55.4%) female with male to female ratio 1: 1.3. Patients' age ranged from 15 to 80 years. Recurrences occurred in 3 ( 1.25%) cases. CONCLUSIONS: Free conjunctival autograft is a safe and effective procedure for prevention of recurrence in pterygium surgery. DOI: http://dx.doi.org/10.3126/jucms.v2i1.10482 ? Journal of Universal College of Medical Sciences (2014) Vol.2(1): 2-6
Effect of Pterygium Surgery on Tear Osmolarity  [PDF]
Kemal Türky?lmaz,Veysi ?ner,Mehmet ?ahin Sevim,Ali Kurt,Berrak ?ekeryapan,Mustafa Durmu?
Journal of Ophthalmology , 2013, DOI: 10.1155/2013/863498
Abstract: Purpose. To investigate changes of dry eye test results in patients who underwent pterygium surgery. Methods. Seventy-four patients who underwent primary pterygium surgery were enrolled in this study. At the baseline, 3-, 12-, and 18-month visits, measurements of tear osmolarity, BUT, and Schirmer test were performed. The patients were divided into 2 groups: Group 1, which consisted of patients in whom pterygium did not recur, and Group 2, which consisted of patients in whom pterygium recurred after surgery. Results. The patients in Group 1 had lower tear osmolarity levels after surgery than those at baseline (all ). In Group 2 the tear osmolarity levels did not differ from baseline after 18 months ( ). The prevalence rates of dry eye syndrome (DES) were lower than that at baseline and 18 months after surgery in Group 1 ( ). In Group 2, the incidence of DES was lower after 3 months than at baseline ( ) but was similar to the baseline rate after 12 and 18 months (both ). Conclusions. Anormal tear film function associated with pterygium. Pterygium excision improved tear osmolarity and tear film function. However, tear osmolarity deteriorated again with the recurrence of pterygium. 1. Introduction Pterygium is a common disease of the ocular surface characterized by the invasion of fibrovascular tissue from the bulbar conjunctiva onto the cornea. It can cause chronic ocular irritation, induced astigmatism, tear film disturbances, and decreased vision secondary to growth over the visual axis [1]. Although the exact etiology of pterygium is unknown, exposure to ultraviolet (UV) radiation is thought to be the major environmental risk factor [2]. Age, hereditary factors, sunlight, chronic inflammation, microtrauma, and dry eye are other possible contributing factors [3–6]. The most commonly accepted treatment for pterygium is surgical excision. However, the rate of recurrence after surgery is high [7]. Several studies have used tear function tests, such as the Schirmer test or tear breakup time (BUT), to investigate the relationship between pterygium and dry eye syndrome (DES), with conflicting results [5, 8, 9]. In addition, a very few studies have evaluated the effects of the excision of pterygium on tear function [10, 11]. Various methods (i.e., the BUT, Schirmer, and mucus fern tests) are available for the investigation of DES. However, these tests are not always reliable, and none of them alone is sufficient for diagnosis [12]. Elevated tear osmolarity has recently been shown to be a reliable indicator of DES, and it has been proposed as a potential gold
Simultaneous pterygium and cataract surgery.  [cached]
Gulani A,Dastur Y
Journal of Postgraduate Medicine , 1995,
Abstract: In our country both pterygium and cataract have a high incidence. Hence in this study, thirty patients with pterygium and cataract were treated with a simultaneous pterygium excision and cataract extraction procedure. These patients after pterygium excision were treated intra-operatively with 500 rads of beta radiation over the pterygium site. Then, the cataract was extracted and the patients were treated post-operatively with topical betamethasone 0.1% for a duration of three months. They were followed up for a duration of 6 months postoperatively. Nineteen patients (63%) had visual recovery to 6/12. Twelve of 30 patients (40%) had recurrence of pterygium. The combined procedure did not result in any surgical complications following cataract removal. Post-operatively, after 6 months 13 patients had with the rule astigmatism (WRA) for a mean WRA of 1.3 D, and 17 had against the rule astigmatism (ARA) for a mean ARA of 1.2 D.
Molecular Effects of Doxycycline Treatment on Pterygium as Revealed by Massive Transcriptome Sequencing  [PDF]
Ignacio M. Larráyoz, Alberto de Luis, Oscar Rúa, Sara Velilla, Juan Cabello, Alfredo Martínez
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039359
Abstract: Pterygium is a lesion of the eye surface which involves cell proliferation, migration, angiogenesis, fibrosis, and extracellular matrix remodelling. Surgery is the only approved method to treat this disorder, but high recurrence rates are common. Recently, it has been shown in a mouse model that treatment with doxycycline resulted in reduction of the pterygium lesions. Here we study the mechanism(s) of action by which doxycycline achieves these results, using massive sequencing techniques. Surgically removed pterygia from 10 consecutive patients were set in short term culture and exposed to 0 (control), 50, 200, and 500 μg/ml doxycycline for 24 h, their mRNA was purified, reverse transcribed and sequenced through Illumina’s massive sequencing protocols. Acquired data were subjected to quantile normalization and analyzed using cytoscape plugin software to explore the pathways involved. False discovery rate (FDR) methods were used to identify 332 genes which modified their expression in a dose-dependent manner upon exposure to doxycycline. The more represented cellular pathways included all mitochondrial genes, the endoplasmic reticulum stress response, integrins and extracellular matrix components, and growth factors. A high correlation was obtained when comparing ultrasequencing data with qRT-PCR and ELISA results. Doxycycline significantly modified the expression of important cellular pathways in pterygium cells, in a way which is consistent with the observed efficacy of this antibiotic to reduce pterygium lesions in a mouse model. Clinical trials are under way to demonstrate whether there is a benefit for human patients.
Surgically induced necrotizing scleritis after pterygium surgery  [cached]
Gokhale Nikhil,Samant Rohini
Indian Journal of Ophthalmology , 2007,
Abstract: We report a case of surgically induced necrotizing scleritis following pterygium surgery with the bare sclera technique, without the use of adjunctive irradiation or mitomycin C. The patient was successfully treated with systemic immunosuppression.
A Comparative Study of Conjunctival Autograft and Minimally Invasive Pterygium Surgery in Primary Pterygia  [PDF]
N. Bazzazi,A. Ramezani,M.A.S. Rabiee
Pakistan Journal of Biological Sciences , 2010,
Abstract: This study aimed at comparing the results of the Conjunctival Autograft Technique (CAG) and Minimally Invasive Pterygium Surgery (MIPS) in primary pterygium excisions. This was a prospective randomized clinical study performed during a one-year period (2009-2010). One hundred and twenty two patients with primary pterygium were randomized in 2 groups: group A (CAG) including 36 patients and group B (MIPS) including 86 patients. The two groups were compared considering the recurrence rate and probable complications of the procedures. Recurrences were detected in 4 patients (11.1%) in group A and 5 patients (5.8%) in group B with no significant difference in this regard (p = 0.447). No major complications occurred during the follow-up period. This study showed that acceptable recurrence- free rates could be achieved (albeit nonsignificant) using MIPS technique in patients with primary pterygium and can be considered as a good alternative in the surgical management of pterygia because of its simplicity and low surgical time.
Steroid induced ocular hypertension following pterygium surgery  [PDF]
BK Khatri,H Ton
Health Renaissance , 2012, DOI: 10.3126/hren.v10i1.6009
Abstract: Background: Steroid induced glaucoma is an important cause of ocular morbidity and blindness. Objective: To determine the incidence of steroid induced ocular hypertension following pterygium surgery. Methods: A total of 202 eyes of 202 patients with primary pterygium which received steroid eye drops after undergoing surgical excision were selected. Pre-operative and post-operative intra-ocular pressure (IOP) were measured and followed up after 2nd and 6th weeks following surgery. Results: Ocular hypertension developed in 47 (23.27 %) eyes. The IOP returned to normal after two weeks following discontinuation of topical steroid drops (dexamethasone) and initiation of anti-glaucoma medication (Timolol drops 0.5% BD). Conclusion: Nearly one fourth of the patients receiving topical steroid following pterygium surgery presented with ocular hypertension. Measurement of IOP as early as 2 weeks of initiation of steroid drops helps identify steroid induced ocular hypertension. DOI: http://dx.doi.org/10.3126/hren.v10i1.6009 HREN 2012; 10(1): 57-58
Preoperative factors influencing success in pterygium surgery  [cached]
Torres-Gimeno Ana,Martínez-Costa Lucía,Ayala Guillermo
BMC Ophthalmology , 2012, DOI: 10.1186/1471-2415-12-38
Abstract: Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue), graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis), and postoperative symptoms (foreign-body sensation, pain). The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women) presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.
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