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Comparing techniques for pterygium surgery
Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan
Clinical Ophthalmology , 2009, DOI: http://dx.doi.org/10.2147/OPTH.S2767
Abstract: mparing techniques for pterygium surgery Original Research (7455) Total Article Views Authors: Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan Published Date September 2008 Volume 2009:3 Pages 69 - 74 DOI: http://dx.doi.org/10.2147/OPTH.S2767 Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan Department of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, Turkey Purpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.
Comparing techniques for pterygium surgery  [cached]
Atilla Alpay,Suat Hayri Ugurbas,Berktug Erdogan
Clinical Ophthalmology , 2008,
Abstract: Atilla Alpay, Suat Hayri Ugurbas, Berktug ErdoganDepartment of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, TurkeyPurpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years.Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients.Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.Keywords: pterygium, comparing, techniques, mitomycin C
Inferior conjunctival autografting for pterygium surgery: an alternative way of preserving the glaucoma filtration site in far western Nepal  [cached]
Shrestha A,Shrestha A,Bhandari S,Maharjan N
Clinical Ophthalmology , 2012,
Abstract: Arjun Shrestha1, Anand Shrestha2, Sujata Bhandari1, Nhukesh Maharjan3, Deepak Khadka1, Suresh Raj Pant1, Bidya Prasad Pant11Geta Eye Hospital, Dhangadhi, 2Tribhuvan University Teaching Hospital, Kathmandu, 3Tilganga Institute of Ophthalmology, Kathmandu, NepalBackground: The purpose of this study was to evaluate the outcome of pterygium excision with inferior conjunctival autografting for primary pterygium.Methods: This was a prospective noncomparative interventional case series study enrolling 50 eyes of 50 patients with primary pterygium between November 1, 2010 and October 30, 2011. All patients underwent the standard surgical technique for pterygium excision with inferior conjunctival autografting. The sampling method was purposive. The study variables were complications of surgery and recurrence rates during a follow-up period of 6 months.Results: The mean age of the patients was 43 ± 7.97 (range 26–64) years. Grade 1 pterygium comprised 64% while grade 2 pterygium comprised 36% of cases. The mean size of pterygium was 3.2 ± 0.60 mm. Minor complications did occur, but only 4% required resuturing. Recurrence occurred in two eyes (4%) which we detected 3 months after surgery in both cases. We observed conjunctival scarring at the donor site in four eyes (8%); however, there was no symblepharon formation or restriction of upgaze.Conclusion: Inferior conjunctival autografting is an effective technique with a low recurrence rate. This is a useful technique when it is not possible or desirable to use the superior conjunctiva as a donor source. It is an especially good option for preserving the glaucoma filtration site for the future.Keywords: inferior, conjunctival, autografting, pterygium surgery, recurrence
Inferior conjunctival autografting for pterygium surgery: an alternative way of preserving the glaucoma filtration site in far western Nepal
Shrestha A, Shrestha A, Bhandari S, Maharjan N, Khadka D, Pant SR, Pant BP
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S29227
Abstract: ferior conjunctival autografting for pterygium surgery: an alternative way of preserving the glaucoma filtration site in far western Nepal Original Research (2449) Total Article Views Authors: Shrestha A, Shrestha A, Bhandari S, Maharjan N, Khadka D, Pant SR, Pant BP Published Date March 2012 Volume 2012:6 Pages 315 - 319 DOI: http://dx.doi.org/10.2147/OPTH.S29227 Received: 15 December 2011 Accepted: 12 January 2012 Published: 01 March 2012 Arjun Shrestha1, Anand Shrestha2, Sujata Bhandari1, Nhukesh Maharjan3, Deepak Khadka1, Suresh Raj Pant1, Bidya Prasad Pant1 1Geta Eye Hospital, Dhangadhi, 2Tribhuvan University Teaching Hospital, Kathmandu, 3Tilganga Institute of Ophthalmology, Kathmandu, Nepal Background: The purpose of this study was to evaluate the outcome of pterygium excision with inferior conjunctival autografting for primary pterygium. Methods: This was a prospective noncomparative interventional case series study enrolling 50 eyes of 50 patients with primary pterygium between November 1, 2010 and October 30, 2011. All patients underwent the standard surgical technique for pterygium excision with inferior conjunctival autografting. The sampling method was purposive. The study variables were complications of surgery and recurrence rates during a follow-up period of 6 months. Results: The mean age of the patients was 43 ± 7.97 (range 26–64) years. Grade 1 pterygium comprised 64% while grade 2 pterygium comprised 36% of cases. The mean size of pterygium was 3.2 ± 0.60 mm. Minor complications did occur, but only 4% required resuturing. Recurrence occurred in two eyes (4%) which we detected 3 months after surgery in both cases. We observed conjunctival scarring at the donor site in four eyes (8%); however, there was no symblepharon formation or restriction of upgaze. Conclusion: Inferior conjunctival autografting is an effective technique with a low recurrence rate. This is a useful technique when it is not possible or desirable to use the superior conjunctiva as a donor source. It is an especially good option for preserving the glaucoma filtration site for the future.
Primary Pterygium a€“ Comparsion of Limbal Conjuncitval Autografting Surgery versus Intra Operative Mitomycin - C (0.02%) after Exicision of Primary Pterygium  [PDF]
Harpal Singh, A S Thakur, B L Sharma
National Journal of Community Medicine , 2011,
Abstract: Pterygium is a fibro vascular encroachment of the conjunctival tissue on the cornea causing variable degree of ocular morbidity. Varies surgical modalities have been developing to reduce the recurrence rate, which is the major limitation of Pterygium surgery. The idea of study is to compare the relative efficacy of two well known procedure i.e. conjunctival autografting and intra operative Mitomycin-C (0.02%) with recurrence to recurrence and complication.
Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft  [cached]
Yamazoe K,Shimazaki-Den S,Otaka I,Hotta K
Clinical Ophthalmology , 2011,
Abstract: Katsuya Yamazoe1,2, Seika Shimazaki-Den1, Isao Otaka3, Kazuki Hotta2, Jun Shimazaki1,4 1Department of Ophthalmology, Tokyo Dental College, Ichikawa, 2Department of Ophthalmology, Kameda Medical Center, Kamogawa, 3Yokohama Sotetsu Building Eye Center, Yokohama, 4Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan Background: Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare. Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning. Results: Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted. Conclusions: SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used. Keywords: scleritis, pterygium, pterygium surgery, conjunctival autograft, SINS
Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft
Yamazoe K, Shimazaki-Den S, Otaka I, Hotta K, Shimazaki J
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S24885
Abstract: rgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft Case report (2508) Total Article Views Authors: Yamazoe K, Shimazaki-Den S, Otaka I, Hotta K, Shimazaki J Published Date November 2011 Volume 2011:5 Pages 1609 - 1611 DOI: http://dx.doi.org/10.2147/OPTH.S24885 Katsuya Yamazoe1,2, Seika Shimazaki-Den1, Isao Otaka3, Kazuki Hotta2, Jun Shimazaki1,4 1Department of Ophthalmology, Tokyo Dental College, Ichikawa, 2Department of Ophthalmology, Kameda Medical Center, Kamogawa, 3Yokohama Sotetsu Building Eye Center, Yokohama, 4Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan Background: Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare. Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning. Results: Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted. Conclusions: SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used.
An Experience of Limbal Autologous Free Conjunctival Grafting in Cases of Pterygium in Rural Western Hilly Region of Nepal  [PDF]
P Bastola
Nepal Journal of Medical Sciences , 2012, DOI: 10.3126/njms.v1i1.5789
Abstract: Background: The study was set in a remote western hilly part of Nepal in the communities of Gulmi, Arghakhnchi and Palpa district of Nepal after seeing the high prevalence of pterygium in those communities.The main purpose of the study was to determine the outcome of free limbal autologous conjunctival grafting from supero temporal quadrant of the eyeball, in cases of pterygium undergoing surgery. Methods : Patients undergoing surgery were evaluated preoperatively, in all cases limbal based supero temporal free autologous conjunctival graft was used, except in cases where it was contraindicated. All the patients’ data were enrolled in to a specifically made proforma for the study. Cases undergoing surgery were followed up, up to one year period. Statistical analysis was performed using Statistical Package for Social Services version 12.0 (SPSS). Results: Hundred and fifteen eyes of 115 patients were included in the study. Ten (8.6%) cases had primary nasal and temporal pterygia both, while five (4.3%) cases in the study were recurrent pterygium. Commonest complication post operatively encountered were foreign body sensation, ocular discomfort, redness, while two cases had flap retraction which was sutured back. None of the patients had recurrence of the pterygia till the last follow up period. Conclusion: This study has shown that free limbal based autologous conjunctival graft is one of the safe surgical techniques for Pterygium treatment with excellent outcome especially in those parts of area where modern pterygium surgery are difficult to do with various restrictions. Keywords: Pterygium; limbal autologous grafting; graft retraction DOI: http://dx.doi.org/10.3126/njms.v1i1.5789 ? Nepal Journal of Medical Sciences. 2012; 1(1): 11-14
Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon
Mohammed I
Clinical Ophthalmology , 2013, DOI: http://dx.doi.org/10.2147/OPTH.S40472
Abstract: e- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon Case report (817) Total Article Views Authors: Mohammed I Published Date January 2013 Volume 2013:7 Pages 199 - 202 DOI: http://dx.doi.org/10.2147/OPTH.S40472 Received: 19 November 2012 Accepted: 12 December 2012 Published: 23 January 2013 Isyaku Mohammed Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria Background: Treatment of recurrent pterygium associated with symblepharon usually involves the use of tissue grafting and/or the intraoperative application of mitomycin C (MMC). For the graft, a conjunctival/limbal autograft and/or amniotic membrane may be used. This generally requires extra technical skills and assistance, an increase in the cost and duration of surgery, and a more extensive anesthesia (a complete eye block or general anesthesia). Although widely used, safety concerns have been raised over MMC in the treatment of pterygia. Objective: The objective of this case report is to report the successful use of preoperative subconjunctival injection of low-dose (0.02%) MMC one month before bare sclera excision of a multirecurrent pterygium, as well as the concomitant intraoperative application of MMC to the conjunctival fornix of the same eye after the excision of an associated symblepharon. Case report: A 31-year-old man from Kano, Northern Nigeria, presented to the eye clinic with a recurrent pterygium associated with an upper lid symblepharon in his right eye. He has had five previous pterygium excisions, with the last surgery involving conjunctival autografting and subconjunctival steroid injection. He was subsequently given 0.1 mL of 0.02% MMC as a subpterygial injection; one month later he had an alcohol-assisted bare sclera pterygium excision and a symblepharolysis with the intraoperative application of 0.02% MMC for 1 minute to the upper conjunctival fornix. Except for a Tenon granuloma that was simply excised, there has been no recurrence or other complications up to a year after surgery. Conclusion: As a cheaper and technically easier treatment option, a preoperative subconjunctival MMC injection followed by bare sclera pterygium excision was found to be effective in this patient with a recurrent pterygium. As at one-year follow-up, low-dose preoperative MMC a month prior to surgery also appeared safe and effective when combined with its intraoperative application to the conjunctival fornix for the treatment of associated symblepharon.
Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon  [cached]
Mohammed I
Clinical Ophthalmology , 2013,
Abstract: Isyaku MohammedDepartment of Ophthalmology, Aminu Kano Teaching Hospital, Kano, NigeriaBackground: Treatment of recurrent pterygium associated with symblepharon usually involves the use of tissue grafting and/or the intraoperative application of mitomycin C (MMC). For the graft, a conjunctival/limbal autograft and/or amniotic membrane may be used. This generally requires extra technical skills and assistance, an increase in the cost and duration of surgery, and a more extensive anesthesia (a complete eye block or general anesthesia). Although widely used, safety concerns have been raised over MMC in the treatment of pterygia.Objective: The objective of this case report is to report the successful use of preoperative subconjunctival injection of low-dose (0.02%) MMC one month before bare sclera excision of a multirecurrent pterygium, as well as the concomitant intraoperative application of MMC to the conjunctival fornix of the same eye after the excision of an associated symblepharon.Case report: A 31-year-old man from Kano, Northern Nigeria, presented to the eye clinic with a recurrent pterygium associated with an upper lid symblepharon in his right eye. He has had five previous pterygium excisions, with the last surgery involving conjunctival autografting and subconjunctival steroid injection. He was subsequently given 0.1 mL of 0.02% MMC as a subpterygial injection; one month later he had an alcohol-assisted bare sclera pterygium excision and a symblepharolysis with the intraoperative application of 0.02% MMC for 1 minute to the upper conjunctival fornix. Except for a Tenon granuloma that was simply excised, there has been no recurrence or other complications up to a year after surgery.Conclusion: As a cheaper and technically easier treatment option, a preoperative subconjunctival MMC injection followed by bare sclera pterygium excision was found to be effective in this patient with a recurrent pterygium. As at one-year follow-up, low-dose preoperative MMC a month prior to surgery also appeared safe and effective when combined with its intraoperative application to the conjunctival fornix for the treatment of associated symblepharon.Keywords: mitomycin C, pterygium, recurrence, symblepharon
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