The Effect of a Novel Strategy in Treating Primary Pterygium: A Prospective Randomized Clinical Study

Advances in the application of gelatin-based materials in anterior segment diseases

Anterior segment diseases are among the most common ocular conditions, severely impacting individuals' visual health. Additionally, due to the barrier functions of the anterior segment tissues, traditional treatment methods often suffer from low efficiency and significant side effects, presenting urgent challenges that need to be addressed. Gelatin inherently possesses excellent biocompatibility and biodegradability, and when combined with its unique cell adhesion sequences and the ability to flexibly modulate mechanical and optical properties through physical and chemical modifications, it demonstrates tremendous potential in anterior segment tissue engineering and drug delivery applications. Compared to conventional surgical and eye drop therapies, gelatin-based materials can reduce the risk of complications, enhance drug bioavailability, extend drug retention time, and achieve personalized and precise treatment for various anterior segment diseases through technologies such as 3D bioprinting. However, gelatin-based materials have limitations, including low mechanical strength and thermal stability. Therefore, this paper focuses on recent research regarding the application of gelatin-based materials in anterior segment diseases, systematically summarizing their advantages in treatment, the challenges they face, and their developmental potential.

Pharmacological treatment strategies of pterygium: Drugs, biologics, and novel natural products

Pterygium is a fibrovascular tissue growth invading the cornea. Adjunctive treatment post-surgery includes conventional immunosuppressants as well as antiviral drugs. The use of large- and small-molecule antivascular endothelial growth factor (VEGF) agents remains an integral part of pterygium treatment as well as other neovascular conditions of the eye. Naturally occurring polyphenolic compounds have favorable characteristics for treating neovascular and inflammatory eye conditions, including good efficacy, stability, cost-effectiveness, and the versatility of their chemical synthesis. In this review, we discuss pharmacological treatments of pterygium. Natural products, such curcumin, ellagic acid, and chalcones, are reviewed, with emphasis on their potential as future pterygium treatments.

Sutureless transplantation using a semi-interpenetrating polymer network bioadhesive for ocular surface reconstruction

The conjunctiva covers the largest area of ocular surface and is responsible for tear balance and clear vision. After trauma or surgery, the conjunctiva is prone to scarring and contracture. Transplantation with suture often implies numerous complications, such as inflammation, suture erosion, granuloma. And the suture needs to be removed, which means a secondary trauma. In this study, a (GMO) for sutureless conjunctival transplantation was developed based on a semi-interpenetrating polymer network (sIPN) consisting of gelatin methacrylate (GelMA) and oxidized hyaluronic acid (OHA). The maximum adhesion strength was 157 ± 17 kPa, and the burst pressure was 357 ± 29 kPa, which was 15 times higher than the human intraocular pressure (IOP). GMO bioadhesive hydrogel significantly improved surgical efficiency and secured the collagen scaffold firmly to a rabbit conjunctival defect. The sutureless transplantation approach revealed the promoted tissue repair without scar. In conclusion, GMO bioadhesive may be an attractive alternative to suture for ocular surface reconstruction by avoiding suture-related complications and improving clinical outcome. STATEMENT OF SIGNIFICANCE: Conjunctival tissue is prone to scarring and contracture after trauma, and surgery with sutures often implies numerous complications. In this study, the ocular surface reconstruction was achieved by sutureless transplantation of conjunctival scaffold using bioadhesive hydrogel. The prepared GMO bioadhesive based on the semi-interpenetrating network of gelatin methacrylate (GelMA) and oxidized hyaluronic acid (OHA) had favorable adhesion and mechanical properties. The sutureless transplantation approach significantly improved the operation efficiency, avoided suture-related complications, and promoted the regeneration of conjunctiva. This study highlights the great potential of the sutureless repair strategy for clinical application in ocular surface reconstruction.

Evaluating the Efficacy and Safety of Different Pterygium Surgeries: A Review of the Literature

The search for the "gold standard" in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.

Efficacy and Safety of Amniotic Membrane Transplantation Combined with Closure of Tenon Capsule and Bulbar Conjunctival Space in the Treatment of Primary Pterygium

Objective

The aim of the study is to evaluate the safety and effectiveness of amniotic membrane transplantation combined with the closure of the tenon capsule and bulbar conjunctival space.

Methods

This study retrospectively included 100 patients with primary pterygium who received closed bulbar conjunctiva and tenon capsule space combined with amniotic membrane transplantation in our hospital from January 2020 to June 2021 as the experimental group and 100 patients with routine treatment in the same period as the control group. The postoperative efficacy evaluation and postoperative complications of the two groups were compared, so as to comprehensively evaluate the safety and effectiveness of this method.

Results

The results showed that the postoperative complications of the two groups were significantly improved by Fisher's exact test (χ² = 14.510, P = 0.006 < 0.05). The comparison results showed that the treatment group showed significant advantages in six indexes compared with the observation group and the difference between the two groups was statistically significant (P < 0.05) of in the NRS score, Prabhasawat score, inspection of the ocular surface comprehensive analyzer, corneal fluorescein staining, conjunctival fluorescein staining in the operation area, breakup time of tear film examination of the two groups at 3, 7 and 14 days, and 1, 6 and 12 months after the operation.

Conclusions

Amniotic membrane transplantation combined with the closure of the tenon capsule and bulbar conjunctival space is safer than conventional surgery in the treatment of primary pterygium. It has a shorter recovery time, higher safety, and a positive curative effect. It can be considered to popularize this operation in clinic.

Evaluation of the Efficacy of Different Pterygium Surgeries in Polish Caucasian Population

The aim of the study was to compare the efficacy of the two most commonly used surgical methods for pterygium removal in the Polish population, conjunctival autograft versus amniotic membrane transplantation, and to evaluate the postoperative recurrence rate. A retrospective analysis of the medical records was conducted, including 65 patients who underwent surgery for primary or recurrent pterygium at an ophthalmology clinic in Bialystok, Poland, between 2016 and 2020. Surgical success (no regrowth) was achieved in almost half of the amniotic membrane patients (44%) and in most of the conjunctival autograft patients (79%), with statistical significance. The odds of successful surgery were 79% lower for subjects with amniotic membranes than for those with conjunctival autografts (OR with 95% CI = 0.21 (0.05; 0.94); $p=0.045$ ). Our study confirms that the conjunctival autograft surgeries present more favorable success rates in Polish Caucasian population when compared to procedures involving amniotic membranes.

Application of platelet-rich fibrin grafts following pterygium excision

PURPOSE

To compare the efficacy, safety and recurrence rate of platelet-rich fibrin (PRF) grafts and limbal conjunctival autografts (LCAs) following pterygium excision.

METHODS

A total of 108 patients (108 eyes) with primary pterygium were included in this study and were divided into group A (56 eyes) and group B (52 eyes). Patients in group A underwent excision of the pterygium followed by LCA while patients in group B underwent PRF grafts following pterygium excision. The PRF was produced using the patient's own whole-blood sample by centrifugation and extrusion. The surgery time, intraoperative complications, postoperative complications, recurrence rate, intraocular pressure (IOP) and follow-up period were recorded and evaluated between the two groups.

RESULTS

The mean surgery time was significantly shorter in group B (25.0 ± 4.2 min) than in group A (36.5 ± 6.3 min) (P < .001). Recurrence was observed in two cases (3.6%) in group A while no recurrence was observed in group B. No graft loss was observed in either group. No other intra/postoperative complications such as a tear in the graft, injury to the medial rectus muscle, excessive bleeding, scleral necrosis, graft oedema, graft necrosis, pannus formation or symblepharon appeared in either group.

CONCLUSIONS

This study presented with a promising outcome of PRF graft applications in primary pterygium surgery. The use of PRF following pterygium excision is a simple, easily applicable, and comfortable method for both patients and surgeons, with less time consumption, recurrence rate and complications, which could be widely used in pterygium management.