Ethnicity is associated with development of pterygium. Taylor HR, West SK, Rosenthal FS, Munoz B, Newland HS, Emmett EA Corneal changes associated with chronic UV irradiation Arch Ophthalmol 1989 107 1481 4, 5. Excision of the cyst with complete closure is recommended. A: Early dehiscence in the nasal side of the graft and sub-graft hemorrhage under the graft. It would take time to recovery and he did not want to waste time for each surgery for both eyes. The bodies of the nasal and temporal pterygium were marked. Bethesda, MD 20894, Web Policies compared 10.0 nylon suture (30 eyes) and fibrin glue (22 eyes); they did not observe any differences between these two materials in terms of frequency of complications [9]. No complications such as infection, corneal thinning or graft dislocation were seen. Recurrent pterygium is more difficult to treat than primary pterygium because it is often accompanied by increased conjunctival inflammation and accelerated corneal involvement. Similarly, the temporal pterygium was excised. -, Br J Ophthalmol. Hemorrhage can also happen in inflamed pterygium; therefore, inflamed pterygium has to be controlled by anti-inflammatory agents or low potent steroid before surgery. Overenthusiastic use of antimetabolites can lead to scleral complications. Pterygium - StatPearls - NCBI Bookshelf - National Center for Patients with systemic hypertension should continue their antihypertensive medications to prevent rebleed. Liang W., Li R., Deng X. The temporal half of the graft was placed on the temporal bare sclera. Tseng S.C., Di Pascuale M.A., Liu D.T., Gao Y.Y., Baradaran-Rafii A. Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocular surface diseases. The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study. and transmitted securely. official website and that any information you provide is encrypted E-mail: [emailprotected]. Federal government websites often end in .gov or .mil. Results: The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). The datasets analyzed during this study are available from the corresponding author on reasonable request. After performing the same procedure on the nasal pterygium, a single piece of conjunctival tissue was taken from the superior bulbar conjunctiva of the same eye and divided into two pieces vertically based on the area of the removed pterygium and placed leaving no open scleral tissue starting from the nasal and temporal limbus, with the epithelial side up and the limbal area aligned with the limbus. In this manuscript, an interesting rare case of a bilateral double-headed recurrent pterygium and vertical split conjunctival autograft transplantation (CAT) simultaneous surgery (to both nasal and temporal parts of the right eye) was presented. Before Hence, we recommend intraoperative visualization of the base and the posterior surface of the pterygium during excision. But, no complications such as infection, corneal thinning or graft dislocation were seen. Most of the immediate postoperative complications of pterygium surgery are not vision-threatening and resolve rapidly. Postoperative complications in pterygium removal can be related to the surgical technique itself or to any of the adjuvant options used. Hemostasis was achieved with the use of wet field cautery. Our patient was a male field worker and smoker living in Hatay (a sunny city located in the southernmost of Turkey). Pterygium Treatment & Management - Medscape Burcu A, Yalnz-Akkaya Z, ingar zdemir E, zbek-Uzman S. Turk J Ophthalmol. Rezvan F, Hashemi H, Emamian MH, Kheirkhah A, Shariati M, Khabazkhoob M, et al. Background: The use of topical mitomycin (mitomycin-C) as a medical adjunct to pterygium and glaucoma surgery is increasing.Methods: The authors report on a series of 10 patients who experienced serious, vision-threatening complications associated with the use of this drug after pterygium surgery.Results: Complications included severe secondary glaucoma (4 patients), corneal edema (3 patients . (Fig. Patients with less than 6 months of follow-up were excluded from the study. Hecht F, Shoptaugh MG. Winglets of the eye: dominant transmission of early adult pterygium of the conjunctiva. Subconjunctival hemorrhage was seen in 722 cases (34.29%) in primary pterygium and 190 cases (75.69%) of recurrent pterygium with a significant P < 0.000001. To the best of our knowledge, this is the first study with a large sample size and a long follow-up period from the southern part of India. Allan BD, Short P, Crawford GJ, Barrett GB, Constable IJ, 7. Graft loss occurred in 16 cases (0.76%) of primary pterygium and in 6 cases (2.39%) of recurrent pterygium, with a significant P value (P = 0.0284). McAllister IL, et al. He told that his mother and sister had also pterygium. Pterygium (Surfer's Eye): Diagnosis, Symptoms & Treatment (b) Graft edema. Ramalho F.S., Maestri C., Ramalho L.N., Ribeiro-Silva A., Romo E. Expression of p63 and p16 in primary and recurrent pterygia. A total of 2356 eyes in 2028 patients were included in the study. 2b] was present post pterygium excision. Kositphipat K, Tananuvat N, Choovuthayakorn J. Int Ophthalmol. The patients with tendencies for keloid formation and hypertrophic scar are at high risk of developing such complication. CAT is reliable, uncomplicated, fast surgery without loss of tissue and prevents recurrence of pterygium. Pterygium - Meaning, Causes, Symptoms, Types and Images - HexaHealth Schirmer test was also applied and both eye values were 30 mm. No complications such as infection, corneal thinning or graft dislocation were seen during the 1.5-month follow-up. Song Y.W., Yu A.H., Cai X.J. The only complication was mild conjunctival avascularity in areas of pterygium excision in 30% of patients. 2004 Jul 15;59(4):1138-47. doi: 10.1016/j.ijrobp.2003.12.021. Cases were monitored for recurrence and complications. [6] suggested that young age,recurrenttype of pterygium, and larger pterygial tissue are risk factors forpterygiumrecurrence after surgical excision. Comparison of the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation. Complications Prognosis Additional Resources 5References Disease Entity Pterygium, from the Greek pterygos meaning "wing", is a common ocular surface lesion originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea. Complications between primary and recurrent pterygia were compared [Table 2]. An Sr-90 eye applicator is used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Funding/Support: None. There were no other ophthalmic or systemic pathologies in our case. BMC Ophthalmol. our patient had a bilateral pterygium and did not have amblyopia or eccentric fixation. Janson BJ, Sikder S. Surgical management of pterygium. He had no history of any ocular surgery except for pterygium surgery 15 years ago in both eyes. In graft transplantation, fibrin glue shortens the operation time and enhances the post-operative comfort, compared with the use of sutures [8-1]. Recurrent Pterygium: A Review - PMC - National Center for Biotechnology Altinkaynak H, Demircan A, Kocasarac C, Kara N, Dundar H, Altan C, et al. The complications post pterygium excision and auto-grafting include subconjunctival hemorrhage, graft edema, graft loss, retraction, graft sliding, granuloma, and recurrence. The patients who had undergone pterygium excision in a tertiary center in South India, between 2010 and 2018, were retrospectively analyzed for complications after surgery. 18. The prevalence and risk factors for pterygium in an adult Chinese population in Singapore: the Tanjong Pagar survey. Medical Care Patients with pterygium can be observed unless the lesions exhibit growth toward the center of the cornea or the patient exhibits symptoms of significant redness, discomfort, or. Aust J Ophthalmol. MeSH The complications that have been noted include intra-operative complications like perforation of the globe, thinning of sclera or cornea from dissection, intraoperative bleeding, muscle injury, buttonholing, graft tear. Pterygium in Indonesia: prevalence, severity and risk factors. Subconjunctival hemorrhage [Fig. Koranyi et al., reported that the operation time had been shortened, postoperative pain was significantly lower, with no complications with using fibrin glue in conjunctival transplantation in pterygium surgery [19]. This growth covers the white part of the eye (sclera) and extends onto the cornea. Xu L, Jonas JB, Cui TT, You QS, Wang YX, Yang H, et al. This may lead to scleral thinning and perforation. Postoperative medication is important and instillation of 0.05% cyclosporine is safe and efficient [39]. Prophylactic removal and microbiological evaluation of calcified plaques after pterygium surgery. Other severe complications like corneal melt [Fig. Corneal dellen developed in 3 (3.26%) patients and 2 of them regressed Das S, Ramamurthy B, Sangwan VS. Balanced salt solution was injected into the superior conjunctiva to aid in the dissection of the graft. It is usually seen as a triangular fleshy fibrovascular proliferation from the bulbar conjunctiva onto the cornea, located mostly on the nasal side. Sixteen (17.39%) out of 92 patients were detected with a non-recurrence complication. A small nick was given using vannas scissor near the forniceal end and a large graft was dissected from the underlying tenons till the limbus. [1314] A meta-analysis done by Vito et al. Maharshak I, Avisar R. Bilateral primary pterygia: an occupational disease? The pathological report was consistent with pterygium. Based on the involvement of pterygium over the cornea they were graded (Grade 1: crossing limbus; Grade 2: midway between limbus and pupil; Grade 3: reaching up to pupillary margin; and Grade 4: crossing pupillary margin. The average age of 16 patients was 49.6816.62 (range 29 to 81) years and mean follow-up time was 19.855.9 months (range 12-35 months). If the excised layer is thin, it will not cause significant problems postoperatively. Intraoperative use of antimetabolites, namely mitomycin C (MMC), reduces the risk of recurrence. 22) Corneal dellen developed in three patients (3.26%). An official website of the United States government. MMC 0.5 mg/mL has also been used after pterygium excision and beta-irradiation, which leads to complications such as scleromalacia, scleral ulcer, and cataract. Corneal scar, either a macular or nebular opacity, depending upon the depth of corneal involvement may be observed from the immediate postoperative period. However, if the depth of lamella is more, there can be scleral thinning and uveal exposure later. This can occur in eyes in which the Tenons layer was exposed. 2c] which did not cause any symptoms to the patient. The recurrence was defined as fibrovascular tissue growth of 1.5 mm or more beyond the limbus onto the clear cornea with conjunctival dragging. The .gov means its official. Pterygium - EyeWiki HHS Vulnerability Disclosure, Help Pterygium excision with conjunctival autograft is a widely performed surgery for pterygium. Lu J, Wang Z, Lu P, Chen X, Zhang W, Shi K, et al. It can be noted that it was significantly more in recurrent pterygia about 75.69% (P < 0.05). They concluded that a single dose of 0.5 mg/mL subconjunctivally gives the same results as multiple drops do, but with far less morbidity. Early postoperative complications . [5] performed sequential pterygium excision with CAT in the management of double-headed pterygium. Pterygium Surgery: Procedure, Recovery Time, and More - Healthline They also recommended early excision ofpterygiumto reduce the recurrence rate. To Deep lamellar keratoplasty for recurrent advanced pterygium. It is often slightly raised and contains visible blood vessels. . sharing sensitive information, make sure youre on a federal The possible reasons for the poor adhesion are due to improper application of tissue glue or sutures. Pterygium in an aged Mongolian population: a population-based study in China. Correspondence to: Assoc. Our hypothesis was that MMC used on the bulbar conjunctiva after pterygium . A pterygium is a noncancerous growth that starts in the clear, thin tissue ( conjunctiva) of the eye. Drugs to avoid recurrence like mitomycin C or 5-fluorouracil were not used. Severe corneoscleral infection. Evolving surgical methods have been associated with some complications, whose diagnosis and management are necessary for ophthalmic surgeons. Seven patients (7.61%) required additional simple surgical interventions such as conjunctival cyst excision and suturing, one patient (1.08%) required amniotic membrane transplantation while eight patients managed conservatively. Postoperatively, type of procedure, visual acuity, complications, duration of follow up was noted. Yalcin Tok O, Burcu Nurozler A, Ergun G, Akbas Kocaoglu F, Duman S. Topical cyclosporine A in the prevention of pterygium recurrence. It inhibits synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and proteins. 2016 Mar;254(3):553-9. doi: 10.1007/s00417-015-3238-1. Although fibrin glue is a material that shortens operation time, improves postoperative patient comfort and decreases inflammation, patients should be carefully followed in the postoperative time period for any possible complications. 1h and 1i] was seen in 34 patients (1.44%). About 1 cc of 2% Xylocaine (AstraZeneca, UK) was injected into the head of nasal pterygium. We had no fibrin glue in our clinic available. The study was conducted in accordance with the tenets of the Declaration of Helsinki patients, with the approval of the local ethical review board. Post-operatively the most common complication noted was subconjunctival hemorrhage/hematoma at the pterygium excision site. Br J Ophthalmol. Cha D.M., Kim K.H., Choi H.J., Kim M.K., Wee W.R. A comparative study of the effect of fibrin glue versus sutures on clinical outcome in patients undergoing pterygium excision and conjunctival autografts. One of the major limitations of pterygium excision is the high rate of postoperative recurrence. Complications of Pterygium Surgery | Ento Key Federal government websites often end in .gov or .mil. Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. In order to provide the structural features of PPG, and to further explore its pathogenetic mechanism, we analyzed clinical and pathological characteristics of 12 PPG cases. A 60-year-old man with these complications was reported by a bare sclera technique without adjunctive therapy [32]. In the study of Lee JS et al. Table 2 mentions the list of all the complications with their respective percentage. They mentioned that CAT from the same site several months later does not appear to increase the rate of recurrence and sequential CAT is a safe and effective method of addressingdouble-headedpterygium [5]. Patients were administered topical antibiotics (0.3% Ofloxacin, Exocin), steroids (0.10% Fluorometho-lone, FML) and preservative-free artificial tear drops (Hydroxypropyl methylcellulose, Tears Naturale Free) 4 times a day for 1 month. Various methods have been reported in pterygium surgery for reducing recurrence and complications, in order to obtain a smooth corneal surface and to achieve an easy and safe operation. A literature review was performed based on the results yielded from searching PubMed, Embase, Web of Science, Scopus, and Cochrane database using the follow-ing keywords: pterygium, complications, etiolo- Romano V, Cruciani M, Conti L, Fontana L Fibrin glue versus sutures for conjunctival autografting in primary, 16. To present complications of using fibrin glue in conjunctival-limbal autografting in pterygium The Pathogenesis of Pterygium: Current Concepts and - ScienceDirect Marticorena J, Rodrguez-Ares MT, Tourio R, Mera P, Valladares MJ, Martinez-de-la-Casa JM, et al. Lee JS, Ha SW, Yu S, Lee GJ, Park YJ. A similar procedure was followed for recurrent pterygium, except that, a thin block of corneal tissue, about 0.5 mm of the peripheral cornea was dissected at a depth of roughly 0.10.2 mm and was included in the conjunctival graft. 6 The postoperative instillation of MMC 0.02% (0.2 mg/mL) eye drops twice daily for 5 days following excision of primary pterygium has been used to reduce recurrence. 1f and 1g] was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. The age of the patients at treatment ranged from 27 to 69 years (mean 48 +/- 11), and complications were assessed 3 to 20 years later (mean 12 +/- 3). may email you for journal alerts and information, but is committed No conflict of interest has been presented. modify the keyword list to augment your search. Effectiveness of amniotic membrane transplantation combined with mitomycin C in the treatment of pterygium: a meta-analysis. Patients with serious systemic illness, glaucoma, vitreoretinal disorder and ophthalmological diseases such as dry eye syndrome and pemphigoid were excluded from the study. Results of pterygium excision adjunct with conjunctival autograft transplantation for primary pterygium by ophthalmology trainees. While doing the lamellar dissection of the pterygium on the corneal surface, the crescent blade can go deeper and cause disruption of normal corneal uninvolved stroma. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications. Some surgeons prefer to use monofilament nylon for suturing the autograft due to an increase in inflammation with Vicryl sutures. The following postoperative complications were noted in these 2356 cases. Hence, surgeons should take precaution not to dissect deeper, and a preoperative anterior segment optical coherence tomography can aid in such situation to determine the depth of dissection. 1 As the experimental models have failed to induc. Kurna S.A., Altun A., Aksu B., Kurna R., Sengor T. Comparing treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting. diagnosed with cyst formation between the graft and conjunctiva or in the graft-removal area; these cysts were primarily Pterygium, Double-headed, Recurrent, Bilateral, Conjunctival Autograft Transplantation. We preferred to perform pterygium excision combining with CLAG transplantation using fibrin glue to avoid from the recurrences and disadvantages of sutures. The graft was fixed using fibrin glue, Tisseel (Baxter, Vienna, Austria). Improper conjunctival autograft separation, in which the conjunctiva is harvested with thick Tenons layer, may be a risk factor for such complication. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In total we performed this technique in 92 patients and did not detect a serious sight-threatening problem at a minimum 1 year follow up time. Graft edema was seen in 480 cases (22.80%) of primary pterygium and in 42 cases (16.73%) of recurrent pterygium, with a significant P value (P = 0.0350). Our patient was a young man and had a cosmetic worry; additionally, he had bilateral recurrent double-headed pterygium. Arrows show conjunctival autografts in place, Slit-lamp photograph of the patients right eye at the postoperative 1.5-month, showing fine corneal opacity in nasal and temporal sides of peripheral cornea. In case of excessive bleeding which obscures the visibility, the surgeon may cauterize the sclera along with the blood vessel. Pterygium is a relatively common ocular surface disease. Although pterygium is not fully understood, significant progress has been made toward understanding the mechanisms involved . Occurs in the interpalpebral region, usually from the nasal side, and is often bilateral. In contrast to above studies, unexpectedly, outdoor occupations were not found as a risk factor for pterygium in the study of Akinsola FB et al. There were no intraoperative and postoperative complications and concluded that the 180-degree CRA technique was effective and safe in preventing the recurrence of primary pterygium. Pterygium is one of the leading causes of blindness and visual disorder [1, 2]. Ma et al., compared amnion membrane graft and conjunctival autograft combined with MMC treatment, and reported 1% pyogenic granuloma and 1% iatrogenic microhyphema as complications in the amnion membrane group, 1.8% scleral ischemia in the MMC group and 3.6% pyogenic granuloma and 7.3% conjunctival inclusion cyst in the conjunctival autograft group [13]. 1 Conjunctival autograft showed a recurrence of 2.6% (primary), 9.1% (recurrence), and 4.9% (all pterygium). CAT is . Optical coherence tomography images of both eyes were shown in Figure 2. Temporal pterygium was larger and excised firstly. While excising the pterygium, the surgeon can inadvertently excise the underlying scleral lamella also. An official website of the United States government. Chi-square test was used to compare the categorical outcomes, and a P value <0.05 was considered statistically significant. Avisar R, Loya N, Yassur Y, Weinberger D, 3. Li Z, Wu S, Mai J, Xu K, Sun Y, Song Z, et al. Fernandes M., Sangwan V.S., Bansal A.K., Gangopadhyay N., Sridhar M.S., Garg P., Aasuri M.K., Nutheti R., Rao G.N. Serratia marcescens endophthalmitis after pterygium surgery: a case report. Unauthorized use of these marks is strictly prohibited. A retrospective analysis was done to know the complications post pterygium excision with conjunctival autografting. Emmert S, Ueda T, Zumsteg U, Weber P, Khan SG, Oh KS, et al. In another study authors mentioned that sutured limbal conjunctival autografts had a recurrence rate ranging from 0% to 14.29% [9]. This patient was presented because of the rare incidence of bilateral, recurrent and double side corneal involvement. In this retrospective study, we have tried to analyze the complications post pterygium, both immediate and long term for a better understanding of the complication profile. Beta irradiationto preventrecurrenceof pterygia isasignificantcauseof iatrogenic oculardisease. 2,3,4 Lee et al has reported that MMC effects are stronger in recurrent pterygium than those with primary cells. Accessibility Please try again soon. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Pterygium and Pinguecula Surgery: Next-Day Cosmetic Outcomes, Mitomycin C, Glues, Sealants, and Ancillaries in Pterygium Surgery, Complex Pterygium Surgery and Complication Management to Cosmetic Endpoints, Kerato-Refractive and Premium Cataract Surgery with Pterygium, Evolution of the Medical and Surgical Treatments for Pterygium, Current Concepts in Treatments of PterygiumAn Evidence-Based Review, Amniotic Graft Surgery in Ocular Surface Pathologies besides Pterygium. Hemorrhage can occur from the scleral bed after excision of the pterygium, and this has to be controlled by good cautious diathermy. Int J Radiat Oncol Biol Phys. In such cases, scar exploration and release of fibrosis are usually performed. 1980 Sep;64(9):676-9. doi: 10.1136/bjo.64.9.676. Yeung SN, Rubenstein D, Price AJ, Elbaz U, Zhang AQ, Cote E, et al. The conventional method of managing pterygium in cataract cases is to perform the pterygium surgery first followed by phacoemulsification. surgeries other than recurrences and discuss their prevention and management strategies. The conjunctiva may recede in the early postoperative period and expose the underlying sclera ( Fig. There isaneed tomodifythe beta irradiationdosimetryatpresentinuse. Wong TY, Foster PJ, Johnson GJ, Seah SK, Tan DT. sharing sensitive information, make sure youre on a federal FOIA 13.4Scleral thinning after pterygium surgery. Intra-operatively 27 cases had graft tear and 13 cases had buttonholing [Fig. Molho-Pessach V, Mechoulam H, Siam R, Babay S, Ramot Y, Zlotogorski A. Ophthalmologic Findings in H Syndrome: A Unique Diagnostic Clue. National Library of Medicine 2 Pterygium is an enigma and many theories have been . Complete pterygium tissue excision, adequate sized conjunctival autograft, thin graft with minimal tenons, proper orientation of the graft, complete coverage of the bare sclera with proper fixation of the graft to the sclera, preventing post-operative inflammation are all prerequisites to minimise the complications. Pterygium: an update on pathophysiology, clinical features, and 0.5% proparacaine HCl (Aurocaine, Aurolab, India) was used as topical anesthesia. 2d] were seen in only 1 case (0.04%) who was operated on for recurrent pterygium and scleral melt/scleral perforation did not occur in any of the cases.