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      Pterygium surgery by double-sliding flaps procedure: Comparison between primary and recurrent pterygia

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          Abstract

          Purpose:

          This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two conjunctival flaps.

          Methods:

          This retrospective study divided 193 cases of pterygium into the primary (140 cases) and recurrent (53 cases) pterygium groups. Following double-sliding conjunctival transposition flap operation and surgical excision of the pterygium, the success and recurrence rates of pterygial surgery were assessed based on visual acuity and corneal and total astigmatism during follow-up at least 6 months.

          Results:

          Both primary and recurrent pterygium groups showed significant improvements in visual acuity and astigmatism (corneal and total) between before and after this procedure. Total astigmatism and success rate of primary pterygium were significantly better than those for recurrent pterygium. Two cases (1.4%) of primary pterygium and four cases (7.5%) of recurrent pterygium developed recurrence, corresponding to a rate of 3.1% (6/193 cases). The success rates significantly make a difference between primary and recurrent groups but did not differ significantly between the first recurrent and over twice recurrent pterygium. However, visual acuity, cornea, and total astigmatism improved significantly after surgery in first recurrent group but not in over twice recurrent group.

          Conclusion:

          The double-sliding conjunctival flaps surgery appeared to be a useful method, with a better success rate and lower pterygial recurrence in pterygium surgery. Especially, when pterygium is larger or recurrent type, this technique can be easily covered the bare sclera, as compared to any transposition conjunctival flap operation.

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          Most cited references30

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          Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision.

          To compare success rates of conjunctival autografting and bare sclera excision for primary and recurrent pterygium in the tropics and to evaluate risk factors for pterygium recurrence. A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia, matched for age and pterygium morphology, were randomized in 2 separate studies to receive either bare sclera excision or conjunctival autograft. The surgical procedures were performed by one surgeon and reviewed at 1, 3, 6, and 12 months after surgery by an independent observer. Pterygium morphology was clinically graded as atrophic, intermediate, or fleshy according to an assessment of pterygium translucency. Risk factors were assessed using likelihood ratio tests. Weibull curves were used to estimate recurrence rates allowing for the interval censoring. In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision (heretofore referred to as the bare sclera group) had pterygium recur in contrast with 1 (2%) of the 61 cases of conjunctival autograft (heretofore referred to as the conjunctival autograph group) (P<.001, likelihood ratio X2 test). Nontranslucency, or fleshiness of the pterygium, and not age was a significant risk factor for recurrence in the bare sclera group (P<.001, likelihood ratio X2 test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group had pterygium recur, while no recurrences occurred among 17 cases in the conjunctival autograft group. Nontranslucency was again a highly significant factor for recurrence (P<.001, likelihood ratio X2 test). Pterygium recurrence is related to pterygium morphology and fleshiness of the pterygium is a significant risk factor for recurrence if bare sclera excision is performed. Conjunctival autografting for primary and recurrent pterygium is effective in reducing pterygium recurrence compared with bare sclera excision.
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            Conjunctival autograft transplantation for advanced and recurrent pterygium.

            The technique and results of conjunctival autograft transplantation for advanced and recurrent pterygium are presented for 57 eyes of 54 patients. The pterygia were primary in 16 eyes and recurrent in 41; among the latter group, 14 patients had diplopia resulting from cicatricial involvement of the medial rectus muscle. In all cases, free conjunctival grafts from the superotemporal bulbar conjunctiva of the same eye were used to resurface exposed sclera and extraocular muscle. There were no intraoperative complications. Postoperative follow-up ranges from 1 to 67 months, with a mean of 24 months. Only three pterygia have recurred (5.3%); two were successfully remedied by a second conjunctival autograft, whereas the third did not require an additional procedure. In all 14 patients with diplopia, extraocular movement was restored. We recommend this surgical approach as a safe and effective means of treating pterygia complicated by conjunctival scarring with extraocular muscle involvement and requiring concurrent fornix reconstruction.
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              Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology.

              To assess the outcomes and safety of current surgical options and adjuvants in the treatment of primary and recurrent pterygium.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian J Ophthalmol
                Indian Journal of Ophthalmology
                Wolters Kluwer - Medknow (India )
                0301-4738
                1998-3689
                September 2021
                25 August 2021
                : 69
                : 9
                : 2406-2411
                Affiliations
                [1]Department of Ophthalmology, Pusan National University School of Medicine, Pusan, Republic of Korea
                [1 ]Hadan Sungmo Eye Hospital, Pusan, Republic of Korea
                [2 ]Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
                Author notes
                Correspondence to: Dr. Jong Soo Lee, Department of Ophthalmology, Pusan National University College of Medicine and Medical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea, 179, Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea. E-mail: jongsool@ 123456pusan.ac.kr
                Article
                IJO-69-2406
                10.4103/ijo.IJO_2982_20
                8544112
                34427232
                a34502b9-a0ed-4d45-9e70-a253b915bf5f
                Copyright: © 2021 Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 September 2020
                : 21 February 2021
                : 05 March 2021
                Categories
                Special Focus, Ocular Surface and Cornea, Original Article

                Ophthalmology & Optometry
                astigmatism,double-sliding conjunctival flaps,recurrent pterygium

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