Inferior conjunctival autografting for pterygium surgery: an alternative way of preserving the glaucoma filtration site in far western Nepal

The Effect of Autografts from the Inferior and Superior Bulbar Conjunctiva on the Ocular Surface in Primary Pterygium Surgery: A Cytology Study

Objectives

This study aimed to evaluate the effect of using an inferior or superior conjunctival autograft in primary pterygium surgery on the postoperative ocular surface.

Materials and Methods

Forty eyes of 40 patients who underwent pterygium surgery with autograft were included in the study. Cytological cell counts were performed on samples taken from the bulbar conjunctiva by impression cytology before and 1 year after the operation. Schirmer 1 test score, lissamine green conjunctival staining score, tear film break-up time (TBUT), and fluorescein corneal staining scores were evaluated. The pain levels of the patients were evaluated with visual analog scale at postoperative 1 day and 1 week.

Results

Corneal and conjunctival staining, TBUT, and Schirmer test results demonstrated significant improvement in all patient groups after surgery, but there was no difference between groups (p>0.05). In both preoperative and postoperative impression cytology, the number of goblet cells in the inferior bulbar conjunctiva was higher than in the superior bulbar conjunctiva (p<0.001), while there was no such difference in epithelial cell or mucin staining. There were no significant cytological changes postoperatively in either group (p>0.05).

Conclusion

Pterygium surgery with autografting improved tear function tests regardless of graft location. Goblet cell count was higher in the inferior bulbar conjunctiva than in the superior bulbar conjunctiva in both postoperative and preoperative impression cytology. However, there was no significant difference in postoperative epithelial and goblet cell counts or mucin staining between the groups before and after surgery. We think that using the inferior bulbar conjunctiva is an appropriate choice in cases where the superior conjunctiva cannot be used as a graft or when future glaucoma surgery is possible.

Pterygium surgery using inferior rotational conjunctival autograft versus conventional conjunctival autograft with sutures - A comparative study

PURPOSE

To compare the outcomes of pterygium surgery by using an inferior rotational autograft and a conventional superior conjunctival autograft.

METHODS

This was a prospective interventional comparative study of 85 eyes of patients who were divided into two groups of 45 and 40. Standard techniques of both procedures were performed by a single surgeon. Astigmatism, recurrence rates, time taken, and other complications were compared.

RESULTS

All the subjects were in the age group 53 ± 7.56 (40-74) years. Demographic data and type of pterygium were comparable in the two groups. In the rotational group, the preoperative astigmatism was - 2.14 ± 1.36 D, which decreased in 1 week to 1.42 ± 1.11 D, in 1 month to - 1.13 ± 0.99 D, in 3 months to 0.91 ± 0.72 D, and in 6 months to 0.81 ± 0.85 D (P < 0.05 each). Preoperative astigmatism in the conventional group was - 2.63 ± 1.47 D, which decreased to - 1.43 ± 1.04 D in 1 week, -1.18 ± 0.85 D in 1 month, -1.07 ± 0.81 D in 3 months, and - 1.01 ± 0.78 D in 6 months (P < 0.05 each). There was no significant difference between the groups in terms of astigmatism at any follow-up visit (P < 0.05). Complications like dellen, graft edema, and superficial vascularization were seen in both groups. The rotational group had one recurrence (2.86%). No recurrence was noted in the conventional group. None of the complication rates was significantly different between the two groups (P < 0.05).

CONCLUSION

Inferior rotational conjunctival autografting is a good technique for management of pterygium. It has a profile similar to that of conventional conjunctival autograft.

Recurrence rate with inferior conjunctival autograft transplantation compared with superior conjunctival autograft transplantation in pterygium surgery: a meta-analysis

Background

Conjunctival autograft transplantation from superior conjunctiva is often chosen to lower the postoperative recurrence rate for pterygium treatment. However, inferior conjunctival autograft (ICA) might be taken as an alternative surgery method, especially under certain conditions. Consequently, we designed this research to estimate and contrast the result of inferior conjunctival autograft and superior conjunctival autograft (SCA) on the postoperative recurrence rate.

Methods

We searched through network database (PubMed, Embase and Cochrane Central Register of Controlled Trials) to choose suitable randomized controlled trials (RCTs). Based on Cochrane review methods, we evaluated eligibility and risk of bias of included studies. The primary measures included postoperative recurrence rate. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were assessed. RevMan 5.3 software was utilized to conduct statistical analysis.

Results

Four RCTs composed of a total of 438 eyes were included in this meta-analysis, with 234 eyes in the inferior conjunctival autograft group and 204 eyes in the superior conjunctival autograft group. Statistical meta-analysis revealed that the postoperative recurrence rate was similar between the two groups (RR = 0.77, 95% CI: 0.36 to 1.62, P = 0.49). Only two RCTs applied the postoperative pain scale and one of them did not provided adequate numbers.

Conclusions

Our meta-analysis indicated that inferior autograft transplantation and superior autograft transplantation had a similar effect on postoperative recurrence rate. The inferior autograft group might have a less postoperative pain. Subsequent RCTs which have more patients participated and more outcomes are needed to confirm our conclusions in years to come.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01889-4.

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis

PURPOSE

This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects.

METHODS

One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months.

RESULTS

Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant.

CONCLUSION

In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.

Comparison of Inferior and Superior Conjunctival Autograft for Primary Pterygium

PURPOSE

To determine the postoperative symptom by using inferior conjunctival autografting (ICA) rather than superior conjunctival autografting (SCA) after excision of pterygium.

METHODS

This prospective randomized control study evaluated 80 eyes of 80 consecutive patients undergoing primary pterygium surgery. Patients in each subgroup were then randomized into the ICA (n = 40) or SCA (n = 40) group. All patients were asked to return for follow up on days 1, 2, 3, 5, 7, and 14 then at months 1, 3, 6, and 12 postoperatively. Outcome measures were postoperative patient discomfort, corneal epithelial healing time, complications and recurrence rate.

RESULTS

Fluorescein staining revealed complete corneal epithelial healing time was 3.1 ± 0.5 d (range 2-4) in the ICA group and 3.3 ± 0.6 d (range 2-4) in the SCA group (p = 0.11). Pain scores were significantly less in the ICA group than the SCA group on follow-up days 3 and 5 (p < 0.05). Postoperative foreign body sensation scores on follow-up days 5 and 7 were significantly lower in the ICA group than the SCA group (p < 0.05). Epiphora scores were significantly less in the ICA group than the SCA group on follow-up days 3, 5, and 7 (p < 0.05). No statistically significant differences between two groups were found for the overall (conjunctival and corneal) recurrence rates (5% versus 7.5%, p = 0.64). No serious complications were encountered.

CONCLUSION

Pterygium excision with ICA led to less postoperative discomfort for patients with primary pterygium.

Superior versus inferior conjunctival autografts combined with fibrin glue in the management of primary pterygia

PURPOSE

To compare the outcomes of superior versus inferior conjunctival autograft (CAU) in the prevention of recurrence after performing a pterygium surgery in patients with primary pterygia.

METHODS

This was a prospective randomized study of 60 eyes of 60 patients with primary pterygium. All the eyes underwent pterygium excision and were assigned randomly to receive either superior (30 eyes) or inferior (30 eyes) CAU. All grafts were attached with fibrin glue. The patients were followed up on postoperative day 1, day 7, 1 month, 3 months, and 6 months.

RESULTS

Outcome measures included rate of recurrence, mean surgical time, visual analog scale pain score, and amount of pain medication required in the first postoperative week. The mean surgical time, visual analog scale pain score, and amount of pain medication required in both groups were not statistically different. A follow-up of at least 6 months (mean 5.5 ± 1.1 months) was achieved in 49 eyes of 49 patients (24 eyes in the superior CAU group and 25 eyes in the inferior CAU group). One eye in the superior CAU group (4.2%) and 1 eye in the inferior CAU group (4.0%) developed pterygium recurrence. There was no statistically significant difference in the recurrence rates between the 2 groups. In the inferior CAU group, mild localized donor site scarring was noted in 2 patients (8.3%).

CONCLUSIONS

Pterygium excision with superior or inferior CAU secured with fibrin glue is safe and effective. There was no significant difference in surgical time, pain, and recurrence rates of pterygium after excision with superior or inferior CAU.