intraoperative complications of pterygium surgery

A noncomparative, retrospective, interventional case series of pterygium surgery with follow-up longer than 12 months to assess recurrence and other complication rates. sharing sensitive information, make sure youre on a federal Various complications of pterygium surgery can be divided into intra-operative complications and postoperative complications. WebAIMS To compare the rate of recurrence and complication after surgery for primary pterygium performed by one surgeon using either intraoperative mitomycin C or irradiation. Pterygium surgery:Conjunctival autograft using a fibrin adhesive. Tomas T. Sliding flap of conjunctival limbus to prevent recurrence of pterygium. The https:// ensures that you are connecting to the Preoperative subpterygeal injection vs intraoperative mitomycin Mild to moderate corneal scarring [Fig. Graft adherence and positioning is examined 1215 min after surgery. A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Objective: To assess the rate of recurrence, complications, and cosmesis after recurrent pterygium removal with P.E.R.F.E.C.T. At early follow-up, a small amount of gaping at the nasal edge of the graft was seen in 74 cases (36%), and this gaping healed spontaneously without any surgical intervention [Figure 5]. HHS Vulnerability Disclosure, Help Current surgical methods to prevent pterygium recurrence include conjunctival autograft with limbal to limbal orientation, conjunctival flap and conjunctival rotation autograft surgery, and amniotic membrane transplant. [QxMD MEDLINE Link]. (e) Retraction of the graft. Before Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Webrecurrence and complication after primary pterygium surgery performed by one surgeon the pterygium surgery: intraoperative mitomy-cin C (group 1) or irradiation (group 2). Hirst LW. There were no intraoperative complications reported except in two cases where we had to use sutures for securing the graft as we noticed graft was not attaching well with undersurface in these two patients. Pterygium; autograft; electrocautery. Possible risks or complications for pterygium surgery | KindSIGHT Comparison between the triamcinolone and bevacizumab subconjunctivals and changes in Interleukin-1 mRNA expression in pterygium. Cohen RA, McDonald MB. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Another problem is its availability. sharing sensitive information, make sure youre on a federal Ten-year results of a randomized controlled trial comparing 0.02% Complications following Use of Intraoperative Mitomycin-C in Pterygium Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, et al. Pterygium - EyeWiki This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Clipboard, Search History, and several other advanced features are temporarily unavailable. [QxMD MEDLINE Link]. Excessive hemorrhage in the graft bed is tamponed. Analysis of complication profile after pterygium excision, in primary and recurrent pterygia. It is highly cost effective too. The rate of recurrence has been reduced to approximately 5-15% with use of conjunctival/limbal autografts or amniotic membrane transplants at the time of excision. de Wit et al. Transl Vis Sci Technol. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. 8600 Rockville Pike 2011 Nov;152(5):733-8. doi: 10.1016/j.ajo.2011.04.013. The https:// ensures that you are connecting to the Disclaimer. As a result of alterations in local ocular surface homeostasis, the main components of pterygium include proliferative clusters of limbal stem cells (LSCs), complications of pterygium Pterygium was graded depending on the extent of corneal involvement: Grade I crossing the limbus, Grade II mid-way between limbus and pupil, Grade III reaching up to pupillary margin, and Grade IV crossing pupillary margin. No eye developed corneal recurrence in either group. Epub 2012 Oct 27. An eye with grade T3 pterygium (d) in the steroid group showed no conjunctival inflammation at 1 month after surgery (e). One group of patients with pterygium can present with minimal proliferation and a relatively atrophic appearance. To examine the short-term complications of arterial cannulation for intraoperative monitoring and their related risk factors. Granuloma [Fig. [QxMD MEDLINE Link]. WebIntervention: Limbal conjunctival autograft transplantation or low-dose intraoperative mitomycin C application with conjunctival flap technique was performed on recurrent pterygium cases. This technique may be considered if conjunctiva needs to be spared for future surgery (ex: glaucoma surgery). UV radiation, proximity to the equator, dry climates, outdoor lifestyle[1]. Syawal P, Budu B, Hatta M, Massi MN, Ichsan AM, Minhajat R. J Taibah Univ Med Sci. Accessibility Intraoperative Loss of graft being the commonest cause (16 cases in primary, 5 cases in recurrent pterygia group), followed by retraction of the graft (8 cases and 2 cases) and persistent inflammation (2 cases and 1 case) Table 2. Intraoperative Subconjunctival Bevacizumab as an Adjunctive 2000 Apr. The site is secure. The graft was secured on both sides with fibrin glue, Tisseel VH (Baxter AG, Vienna, Austria) ensuring complete coverage of the bare sclera on both sides. 2006 Feb. 244(2):232-6. The diagnosis is most often clear clinically, but histopathologic confirmation is performed routinely, as there can be associated dysplasia of the overlying tissue. Bookshelf Eye. Curr Opin Ophthalmol. Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation. Cogan DG, Kuwabara T, Howard J. Mean follow-up time was 14.6 months. In patients with significantly elevated pterygia, focal drying and subsequent thinning of the adjacent cornea may rarely occur. This prospective study included 205 cases of pterygium of 196 patients with vascular, progressive pterygium, who underwent pterygium excision with conjunctival autografting using no sutures and no glue technique from January 2012 to November 2015. The cost of fibrin glue is quite high. Hirst LW. FOIA The diagnosis is made by slit-lamp examination of the wing-shaped limbal growth at the characteristic location within the palpebral fissure. 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. (PDF) ConjunctivalLimbal Autograft, Amniotic - Share research Safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Non-healing epithelial defect (esp with mitomycin C). Am J Ophthalmol. To avoid the pterygium growing back, you should take the prescribed steroid drops and avoid sun exposure to the eye. 2005 Jul. [QxMD MEDLINE Link]. The donor site healed without any problem except in two cases which showed granuloma formation at the harvested site and had to be removed surgically [Figure 6]. Bekibele CO, Baiyeroju AM, Olusanya BA, Ashaye AO, Oluleye TS. official website and that any information you provide is encrypted Presence of leukoplakia, pigmentation, irregular feeder vessels, atypical elevation, and rapid growth should increase suspicion for malignancy. of intraoperative 5-fluorouracil infiltration Late postoperative complications include recurrence, corneoscleral necrosis, scleritis, endophthalmitis.[12]. Amniotic membrane graft for primary pterygium:comparison with conjunctival autograft and topical mitomycin C treatment. [QxMD MEDLINE Link]. (d) corneal melt, s/p recurrent pterygium excision, List of complications post pterygium with their respective percentage in brackets and comparison of complications between primary and recurrent pterygia with their P value. Cornea. WebHost conjunctival inflammation is still common after intraoperative application of mitomycin C and amniotic membrane transplantation, especially when sutures are used in pterygium surgery. FOIA Results: High resolution anterior segment optical coherence tomography can be used to differentiate pterygia from ocular surface squamous neoplasia (OSSN). Graft retraction [Fig. The overlying epithelium is usually normal, but may be acanthotic, hyperkeratotic, or even dysplastic and often exhibits areas of goblet cell hyperplasia. The pterygia in this group tend to be flatter and slow growing and have a relatively lower incidence of recurrence following excision. Oguz H. Amniotic membrane grafting versus conjunctival autografting in pterygium surgery. A genetic predisposition to the development of pterygia appears to exist in certain families. Keywords: Intraoperative 61:388. [QxMD MEDLINE Link]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MjUyNy1jbGluaWNhbA==, Distortion and/or reduction of central vision, Chronic scarring of the conjunctiva and the cornea, Perforation of the globe, vitreous hemorrhage, or retinal detachment (all rare). The transplants healed with excellent cosmetic result. Complications, conjunctival autograft, conjunctival limbal autograft, pterygium. 2017 May;42(5):696-700. doi: 10.1080/02713683.2016.1236965. This study has summarized the complications of conjunctival autografting in a long term follow up. WebWe evaluated and compared the safety and efficacy of the conjunctival-limbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin C in 94 patients undergoing primary pterygium surgery and concluded that 21(6):865-7. Yin M, Li H, Zhang Y, Dai H, Luo F, Pan Z. Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. For primary pterygium, conjunctival autografting was done without including the limbal tissue. Out of 2028 patients, 914 patients were male and 1114 patients were female. Excision with conjunctival autograft is considered the current gold standard because of its low rate of recurrence. The lesion occurs more frequently at the nasal limbus than the temporal with a characteristic wing-like appearance. Cochrane Database Syst Rev. A major modification of conjunctival autograft surgery was used to treat recurrent pterygia. Singh G, Wilson MR, Foster CS. Share cases and questions with Physicians on Medscape consult. Cosmesis achieved was excellent in all cases. Postoperatively, type of procedure, visual acuity, complications, duration of follow up was noted. Secondarily, pterygium in Oman tends to be more aggressive and vascular due to climatic conditions. To assess the rate of recurrence, complications, and cosmesis after recurrent pterygium removal with P.E.R.F.E.C.T. 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. Design: A noncomparative, retrospective, Granuloma formation is not unusual in pterygium surgery. There have been many attempts to optimize pterygium surgery. Nasal gaping was seen in 36% of cases (74 cases), which healed spontaneously without any surgical intervention. Ophthalmology. WebPatients and methods: One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, Main outcome measure: All the complications were noted during the follow-up period. Destruction of Bowman layer by fibrovascular ingrowth is typical. Soliman Mahdy MA, Bhatia J. 2016 Mar;35(3):413-6 . Threlfall TJ, English DR. Sun exposure and pterygium of the eye: a dose-response curve. 147(3):447-452.e1. Grade 2 outcome after pterygium surgery with a bare-sclera technique and intraoperative MMC, Grade 3 outcome after pterygium surgery with a bare-sclera technique and intraoperative MMC, MeSH Grade 2 outcome after pterygium surgery with a bare-sclera technique and intraoperative MMC application. [QxMD MEDLINE Link]. Would you like email updates of new search results? 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. 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. To report a case series of pterygium surgery with conjunctival autograft fixation using bipolar electrocautery. Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation. In a meta-analysis of 18 RCTs, it was reported that postoperative complications of pterygium surgery were not significantly different between adjuvant bevacizumab group and control group. During our previous study,[7] where we did pterygium excision with conjunctival autograft, we have tried interrupted 80 Vicryl sutures with nonburied knots. Though frequently asymptomatic, pterygia can become inflamed and cause ocular surface irritation. The site is secure. A number of potential therapeutic options exist for the management of pterygia ranging from conservative management with lubrication to surgical excision with conjunctival autografts. Before Simple surgical excision has a high recurrence rate of approximately 50-80%. Clinical, pathological, and molecular aspects of recurrent versus primary pterygium. Sebban A, Hirst LW. Epub 2011 Jul 13. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Careers. However, the use of mitomycin C and 5-fluorouracil can increase the risk of corneal or scleral melt postoperatively[11]. Careers. The presence of the sutures causes significantly more postoperative pain and irritation. and transmitted securely. Epub 2012 Oct 11. Graft retraction was seen in 620 cases (29.45%) and 72 cases (28.6%) in primary and recurrent pterygium respectively, with no significant P value (P = 0.857). Corneal changes associated with chronic UV irradiation. Suture-related complications include infection, granuloma formation, and chronic inflammation, whereas plasma-derived fibrin glue has the potential risk of prion disease transmission and anaphylaxis in susceptible individuals. Indications for and complications of mitomycin-C in pterygium government site. In all the surgical procedures fibrin glue was used for fixation of the autograft. 1961. Complications of pterygium surgery. Recurrence rate in our study is higher (6.8%) as compared to studies done by Malik et al. for: Medscape. [QxMD MEDLINE Link]. 2010 May;117(5):1054.e1-2. William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive SurgeryDisclosure: Received consulting fee from Allergan for consulting; Received consulting fee from Alcon for consulting; Received consulting fee from Bausch & Lomb for consulting; Received consulting fee from Abbott Medical Optics for consulting; Received consulting fee from CXLUSA for none; Received consulting fee from LensAR for none. Patients should be followed to monitor for recurrence. Histologically, pterygia are an accumulation of degenerated subepithelial tissue which is basophilic with a characteristic slate gray appearance on H&E staining. Use of mitomycin C with conjunctival autograft in pterygium surgery in Asian-Canadians. This site needs JavaScript to work properly. The nasal half was released from its base and placed over the nasal bare sclera without changing the orientation. This site needs JavaScript to work properly. Profile of complications in pterygium surgery - A Visual mycin C (MMC) one month before bare sclera 48(2):145-80. (2.5%) and by Rathi et al. From the patients' perspective, greater comfort allows a more rapid return to their normal lifestyle and productivity. Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. (d) Graft sliding. A drooping eyelid which requires corrective surgery 1 in 1000. Epub 2012 Oct 11. After pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural hemostasis and relative desiccation before graft placement. Pterygium surgery: Suture less glue less conjunctival auto grafting. Pterygium is more frequent in areas with more ultraviolet radiation, in hot, dry, windy, dusty, and smoky environments. Thus, bevacizumab can reduce the risk of pterygium recurrence after surgery, and does not differ from placebo or other drug treatments in terms of the risk of complications. WebPterygium extended removal followed by extended conjunctival transplant is an effective technique for primary pterygia and resulted in a 0% recurrence rate with minimal intraoperative and postoperative complications. WebCLAU with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium. Saw SM, Tan D. Pterygium: prevalence, demography and risk factors. 2021 Sep 1;10(11):13. doi: 10.1167/tvst.10.11.13. Eye rubbing causing conjunctival graft dehiscence following pterygium surgery with fibrin glue. Bethesda, MD 20894, Web Policies Complications between primary and recurrent pterygia were compared [Table 2]. 8600 Rockville Pike Post-operatively, all the patients were started on topical antibiotics (0.5% Moxifloxacin), 4 times/day for 2 weeks, topical steroids (0.5% Loteprednol etabonate) 6 times/day for the first week and then tapered gradually, and preservative-free tear substitutes (0.5% carboxymethyl cellulose) for 6 weeks. An increased incidence is noted in latitudes nearer the equator and in individuals with a history of increased UV exposure (outdoor work). The surgeon's skill and experience affect the recurrence rate, which varies between 2% and 39% with this technique. Graft loss occurred in 22 cases (0.93%), of which 16 cases (0.76%) had primary and 6 cases (2.39%) had recurrent pterygium. The entered sign-in details are incorrect. WebThe graft tissue remaining red and inflamed due to rejection requiring surgical replacement 1 in 500. 2013 Jan;120(1):201-8. doi: 10.1016/j.ophtha.2012.06.066. In 1985, Kenyon et al. ?accessibility.screen-reader.external-link_en_US?. [7] and (2) engaging in occupations that require outdoor activities. A total of 205 pterygium of 196 patients (mean age 47.7 years with standard deviation [SD] 9.2 years) underwent pterygium excision with autologous conjunctival graft with no suture, no glue technique. Postoperative conjunctival inflammation after pterygium surgery with amniotic membrane transplantation versus conjunctival autograft. 2a] was seen in one case,which later had recurrecure. (c) Subconjunctival hemorrhage/haematoma. Subconjunctival hemorrhage [Fig. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications. Comparison of Corneal Irregularity After Recurrent and Primary Pterygium Surgery Using Fourier Harmonic Analysis. Would you like email updates of new search results? Adjuvants like Mitomycin C,[9] beta-irradiation,[10] 5-florouracil,[11] have been used along with pterygium excision to reduce the recurrences. 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. 8600 Rockville Pike Prospective trial of intraoperative mitomycin Serious complications of topical mitomycin-C after pterygium surgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 0.5% proparacaine HCl (Aurocaine, Aurolab, India) was used as topical anesthesia. Avisar R, Loya N, Yassur Y, Weinberger D. Pterygium-induced corneal astigmatism. Patients with less than 6 months of follow-up were excluded from the study. Before A higher index of suspicion for concurrent malignancy is required for patients living in areas with higher UV index. The limbal edge of the graft was cut to contain a thin rim of corneal epithelium. Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive SurgeryDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab
Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue
Received research grant from: Glaukos
Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab
stock options for: RPS, Fount Bio. The mean follow-up was 41 months (range 12 to 81 months). In addition, patients' comfort for the first few days after surgery is also an important factor in this type of intervention. The conjunctival graft was taken from the superior conjunctiva. Allan BD, Short P, Crawford GJ, Barrett GD, Constable IJ. Br J Ophthalmol. Bahar I, Weinberger D, Gaton DD, Avisar R. Fibrin glue versus vicryl sutures for primary conjunctival closure in pterygium surgery: long-term results. Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences Malik et al. Neither transplant necrosis nor excessive postoperative bleeding was seen. Raiskup F, Solomon A, Landau D, Ilsar M, Frucht-Pery J. Mitomycin C for pterygium: long term evaluation. Careers, Unable to load your collection due to an error. The study was approved by the institutional ethics committee and adhered to the tenets of the Declaration of Helsinki. In addition, postoperative patching, healing time, and restrictions in normal life after surgery were of concern. Ophthalmology. Boucher S, Conlon R, Teja S, Teichman JC, Yeung S, Ziai S, Baig K. Can J Ophthalmol. PMC In pterygium surgery with a bare-sclera technique and mitomycin C application, intraoperative triamcinolone injection did not significantly reduce postoperative conjunctival inflammation or pterygium recurrence. 2011 Mar. Although incidence of dehiscence is very low and almost similar in all studies including ours, recurrence rate is variable. vascular straightening in the direction of the advancing head of the pterygium on the corneal surface. Federal government websites often end in .gov or .mil. The tissue was left for about 1012 min in place. Because of its biological and biodegradable properties, fibrin-based adhesives are gaining importance and are used instead of sutures under conjunctiva without inducing inflammation. A total of 205 cases of pterygium underwent excision with conjunctival autograft without using sutures or glue. Due to the potential for recurrence of a more aggressive lesion, as well as other surgical risks, the surgical removal of pterygia should not be undertaken casually. No intraoperative complication occurred in either group. 1954. Kheirkhah A, Casas V, Sheha H, Raju VK, Tseng SC. 84(4):385-9. [8] reported no recurrence and no transplant dislocations in their study of 15 cases using no suture, no glue technique. Ocular surface lubrication may also help. Arch Ophthalmol. Both of them used similar technique in all cases to avoid any surgical bias regarding recurrence. 2008 Jan;27(1):56-63. doi: 10.1097/ICO.0b013e31815873da. Romano V, Cruciani M, Conti L, Fontana L. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. [Full Text]. 2011 Nov. 152(5):733-8. the contents by NLM or the National Institutes of Health. 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. MeSH Table 2 mentions the list of all the complications with their respective percentage. PMID: 23107578; PMCID: PMC3562397. 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%). 2022 Sep 9;19(18):11357. doi: 10.3390/ijerph191811357. doi: 10.1016/j.ophtha.2010.01.050. Although the sample size in our sutured graft study was small (43 cases), so we are not very sure about the exact reason behind this, but we feel that with sutures in place, graft and stem cell are more firmly attached against the limbus and therefore reducing the recurrence rate. This prospective study included 54 eyes with primary nasal pterygia that underwent pterygium surgery with a bare-sclera technique and intraoperative mitomycin C application. Princeton University Press; 1959. The complications that have been noted include intra-operative complications like perforation of the globe, thinning of sclera or cornea from dissection, intraoperative Cut-and-place technique of pterygium excision with autograft doi: 10.1002/14651858.CD011349.pub2. Please enter a valid username and password and try again. The use of mitomycin C 0.02% was required (in 52 of cases) in cases of recurrent pterygium or in an extremely inflamed pterygium in a high-recurrence risk patient (young patients). [4,5] The recurrence in most cases is seen within 6 months but can sometimes occur later.[6].

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