Specialist delves into best practices for pterygium surgery
Click Here to Manage Email Alerts
SAN FRANCISCO — Techniques for pterygium excision have not changed significantly from the past, but data from cumulative experience show that conjunctival autograft in combination with surgical excision has the lowest recurrence rate.
According to a practice pattern survey study, this is the preferred technique among cornea specialists, Bennie H. Jeng, MD, said during Cornea Subspecialty Day at the American Academy of Ophthalmology meeting.
Image: Adobe Stock
Removal of pterygium is typically recommended when it causes irritation and inflammation despite topical treatment, when it starts impairing vision, and in the setting of cataract surgery. Because pterygium has significant influences on corneal topographic astigmatism, it will induce errors in IOL power calculation. It is therefore important to have it removed before cataract surgery, Jeng recommended.
Of the many techniques for removal, bare sclera has shown the highest recurrence rate, up to 70% in the literature. Primary closure and excision with sliding or pedicle grafts are somewhere between 30% and 40%, while conjunctival autograft, currently the gold standard, is around 5% to 10%.
Of the various ways to fixate the autograft, fibrin glue was found in studies to require less surgical time and to be the most efficient and cost-effective, while also leading to a significant decrease in inflammation.
Regarding amniotic membrane transplantation, with its many variants, there has been evidence suggesting that the recurrence rate was higher compared with conjunctival autograft, while other evidence suggested that it was not quite as high if glue was used for fixation.
“So, you can find any study to support anything you want to say. But the question is, if we look globally, overall, what do we think statistically is the better way to go? And then the question is, what are our colleagues doing?” Jeng said.
A survey study from the Cornea Society showed that autologous conjunctival autograft, following complete resection including the base and a moderate quantity of Tenon capsule, was the most common procedure.
The biggest complication of pterygium surgery is recurrence, Jeng said. Among the ways to prevent recurrence, which include mitomycin C, tacrolimus, anti-VEGFs and 5-fluorouracil, his personal preference goes to the latter.
“Intralesional 5-FU injection, just a little bit into the head of the advancing pterygium before it reaches the limbus, weekly or biweekly for three times, has always in my book actually stopped the recurrence, and the literature suggests upwards of 80% to 100% of stopping this recurrence,” he said.
An IRIS Registry study looking at 80,000 pterygium surgeries showed that younger patients and male patients were more likely to have recurrence. It also showed that surgeons who did a lower volume of procedures and non-cornea specialists had a higher likelihood of recurrence.
Collapse
Jeng BH. Pterygium: New techniques for an old problem. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
Read more about
Click Here to Manage Email Alerts