Purpose: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. Materials and Methods: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 ± 14.21 years in group 1, 49.63 ± 14.42 years in group 2 and 47.92 ± 15.52 years in group 3. Patients were followed up to 72.39 ± 11.03 months in group 1, 69.91 ± 12.41 months in group 2 and 61.43 ± 9.83 months in group 3. Results: Postoperative corneal epithelialization was completed in 5.62 ± 1.74 days in group 1, 4.33 ± 0.91 days in group 2 and 4.79 ± 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. Conclusions: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

Keywords:
Pterygium, Bare sclera, Limbal-conjunctival autograft, Amniotic membrane
1.
Mackenzie FD, Hirst LW, Battistutta D, Green A: Risk analysis in the development of pterygia. Ophthalmology 1992;99:1056–1061.
2.
Coroneo MT, Di Girolamo N, Wakefield D: The pathogenesis of pterygia. Curr Opin Ophthalmol 1999;10:282–288.
3.
Chowers I, Peer J, Zamir E, Livni N, Ilsar M, Frucht-Pery J: Proliferative activity and p53 expression in primary and recurrent pterygia. Ophthalmology 2001;108:985–988.
4.
Chui J, Di Girolamo N, Wakefield D, Coroneo MT: The pathogenesis of pterygium: current concepts and their therapeutic implications. Ocul Surf 2008;6:24–43.
5.
Adamis AP, Starck T, Kenyon KR: The management of pterygium. Ophthalmol Clin North Am 1990;3:611–623.
6.
McCoombes JA, Hirst LW, Isbell GP: Sliding conjunctival flap for the treatment of primary pterygium. Ophthalmology 1994;101:169–173.
7.
Wilson SE, Bourne WM: Conjunctival Z-plasty in the treatment of pterygium. Am J Ophthalmol 1988;106:355–357.
8.
Krag S, Ehlers N: Excimer laser treatment of pterygium. Acta Ophthalmol 1992;70:530–533.
9.
Kenyon KR, Tseng SCG: Limbal autograft transplantation for ocular surface disorders. Ophthalmology 1989;96:709–723.
10.
Allan BD, Short P, Crawford GJ, Barret GD, Constable IJ: Pterygium excision with conjunctival autografting: an effective and safe technique. Br J Ophthalmol 1993;77:698–701.
11.
Ti SE, Chee SP, Dear KB, Tan DT: Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol 2000;84:385–389.
12.
Guler M, Sobacı G, Ilker S, Ozturk F, Mutlu FM, Yildirim E: Limbal-conjunctival autograft transplantation in cases with recurrent pterygium. Acta Ophthalmol 1994;72:721–726.
13.
Alaniz-Camino F: The use of postoperative beta radiation in the treatment of pterygia. Ophthalmic Surg 1982;13:1022–1025.
14.
Amano S, Motoyama Y, Oshika T, Eguchi S, Eguchi K: Comparative study of intraoperative mitomycin C and beta irradiation in pterygium surgery. Br J Ophthalmol 2000;84:618–621.
15.
Singh G, Wilson MR, Foster CS: Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea 1990;9:331–334.
16.
Avisar R, Weinberger D: Pterygium surgery with mitomycin C. How much sclera should be left bare? Cornea 2003;22:721–725.
17.
Maldonado MJ, Cano-Parra J, Navea-Tejerina A, Cisneros AL, Vila E, Menezo JL: Inefficacy of low-dose intraoperative fluorouracil in the treatment of primary pterygium. Arch Ophthalmol 1995;113:1356–1357.
18.
Dadeya S, Kamlesh, Khurana C, Fatima S: Intraoperative daunorubicin versus conjunctival autograft in primary pterygium surgery. Cornea 2002;21:766–769.
19.
Ozer A, Yildirim N, Erol N, Yurdakul S: Results of autografting of marginal conjunctiva in pterygium excision. Ophthalmologica 2002;216:198–202.
20.
Kilic A, Gurler B: The efficiency of limbal conjunctival autografting in pterygium surgery. Eur J Ophthalmol 2006;16:365–370.
21.
Oguz H, Kilitcioglu A, Yasar M: Limbal conjunctival mini-autografting for preventing recurrence after pterygium surgery. Eur J Ophthalmol 2006;16:209–213.
22.
Dogru M, Tsubota K: Survival analysis of conjunctival limbal grafts and amniotic membrane transplantation in eyes with total limbal stem cell deficiency. Am J Ophthalmol 2005;140:305–306.
23.
Kim JC, Tseng SC: Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 1995;14:473–484.
24.
Rubinfeld RS, Pfister RR, Stein RM, et al: Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 1992;99:1647–1654.
25.
Dunn JP, Seamone CD, Ostler HB: Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy. Am J Ophthalmol 1991;112:343–344.
26.
Barraquer JI, Binder PS, Buxton JN: Etiology and treatment of pterygium; Symposium on Medical and Surgical Diseases of the Cornea. Transactions of the New Orleans Academy of Ophthalmology. St. Louis, Mosby, 1980, pp 167–178.
27.
Starck T, Kenyon KR, Serrano F: Conjunctival autograft for primary and recurrent pterygia: surgical technique and problem management. Cornea 1991;10:196–202.
28.
Tseng SCG: Concept and application of limbal stem cells. Eye 1989;3:141–157.
29.
Kucukerdonmez C, Akova YA, Altinors DD: Vascularization is more delayed in amniotic membrane graft than conjunctival autograft after pterygium excision. Am J Ophthalmol 2007;143:245–249.
30.
Hirst LW, Sebban A, Chant D: Pterygium recurrence time. Ophthalmology 1994;101:755–758.
31.
Vrabec MP, Weisenthal RW, Elsing SH: Subconjunctival fibrosis after conjunctival autograft. Cornea 1993;12:181–183.
32.
Mejia LF, Sanchez JG, Escobar H: Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites. Cornea 2005;24:972–975.
33.
Luanratanakorn P, Ratanapakorn T, Suwan-apichon O, et al: Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision. Br J Ophthalmol 2006;90:1476–1480.
34.
Ma DH, See LC, Liau SB, et al: Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol 2000;84:973–978.
35.
Tananuvat N, Martin T: The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft. Cornea 2004;23:458–463.
36.
Marticorena J, Rodriguez-Ares MT, Tourino R, et al: Pterygium surgery: conjunctival autograft using a fibrin adhesive. Cornea 2006;25:34–36.
37.
Ozdamar Y, Mutevelli S, Han U, Ileri D, Onal B, Ilhan O, Karakaya J, Zilelioglu O: A comparative study of tissue glue and vicryl suture for closing limbal-conjunctival autografts and histologic evaluation after pterygium excision. Cornea 2008;27:552–558.
38.
Figueira EC, Coroneo MT, Francis IC: Preventing conjunctival autograft inversion in pterygium surgery. Br J Ophthalmol 2007;91:83–84.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.