recurrence of the pterygium after excision: what factors do relate it? hong kyun kim dept. of...
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Recurrence of the pterygium after excision: What factors do relate
it?
Hong Kyun KimDept. of Ophthalmology
Kyungpook National University School of medicine
Purpose• To evaluate the factors that influence the re-
currence of the pterygium after excision
Patients and Methods• 37 eyes of patients including 14 males and 23 females
pterygium in the age range of 22 – 66 years (mean age 52.4 years ± 12.1)
• There were 20 eyes of primary pterygium and 17 re-current pterygium.
• Each eyes underwent a complete ocular examination and were taken photograph to evaluate the molpho-logic severity of pterygium
Patients and Methods – Exclusion Criteria
• patients with pseudopterygium• patients with severe dry eye syndrome, meibo-
mian gland dysfunction, neurotrophic keratitis.• if the patients did not follow up at least 6months
Patients and Methods - Preoperaitve morphologic severity grading by Slit lamp Photography
Evaluate the thickness, vascularity, the amount of encroachment on cornea of the fibrovascular pro-liferation - Thickness (T) - Vascularity (V) - Location(L)
Grade of Thickness (T)
• T0 : no elevation
• T1 : minimal elevation with definite con-firmation of episcleral vessel in most of the elevated area.
• T2 : moderate elevation, episcleral ves-sel can be found in some of the elevated area.
• T3 : marked elevation, episcleral vessel cannot be found because of the pterygial fleshiness.
Grade of Vascularity (V)
• We use the computer program (Adobe Photo-shop ver.9.0) to compare the vascularity of each pterygial proliferation
equalized and in-verted photo from original photo
original photograph
Grade of Vascularity (V)
• V0 : no directional vascular pattern
• V1 : minimal vascu-larization with uni-directional patterm
• V2 : moderate vas-cularization with unidirectional and enlarged vessels
• V3 : marked vascu-larization with uni-directional, en-gorged vessels
V0
V2
V1
V3
Location (L)
• L1 : abnormal fibrovascular tissue were con-fined conjunctival area
• L2 : abnormal fibrovascular tissue were lo-cated in limbal area.
• L3 : abnormal fibrovascular tissue were en-croached over limbal area. (> 1.0 mm from limbus)
Surgical Technique
Pterygial Excision Method• Subconjunctival 2% lidocaine• Mark the incision line with the gentian violet • The head of Pterygium was avulsed with a 0.3mm toothed
forceps• Wescott scissors was used to dissect the underlying con-
junctiva and Tenon’s capsule and excised the Tenon.• with or without 0.04% MMC sub Tenon’s soaking for 2min.• excise additional exposed Tenon’s capsuleCovering methods over pterygium excised area• Conjunctival Autograft• Conjuntival Autograft + Amniotic membrane graft• Amniotic membrane graft
Patient F/U
• include who completely followed up over 6months
• Definition of Recurrence “a certain amount of fibrous reproliferation with unidi-
rectional vascularity after excisional operation” - Recurrence that need the Re-operation 1. Recurrence over the > 1mm past the limbus (L3) with
T3 or V3 2. fibrovascular proliferation over L2 with adhesive trac-
tion that results in diplopia - Conjuntival Recurrence Recurrence within L2 and do not cause the diplopia
Evaluation of Risk factor for Recurrence• Univariate Analysis (Chi-squre test, SPSS for Windows ver.12.0,
P<0.05) comparison of the incidence of the recurrence in following variables Preoperative morphologic feature 1. primary / recurrence 2. preoperative fibrous thickness (T2 /T3) 3. preoprative vascularity 4. symblepharous fibrous traction Operation technique 1. amniotic membrane 2. conjunctive autograft
Adjunctive Treatment 1. preopeative TA subconjunctival injection 2. preoperative MMC injection 3. intraoperative 0.04% MMC soaking
• Multivariate analysis (Logistic Regression Analysis, SPSS for Win-dows ver. 12.0, p<0.05))
Results
• follow-up period - mean 8.4 ±4.6 (6-18 months)• Recurrence rate - total recurrence rate 14/37 eyes (37.8%) - conjunctival recurrence rate 10/37 (27.0%) - Recurrence that need the Re-operation 4/37 (10.8%
• There were no statistic significance in preoperative mophologic variables and Adjunctive treatment
• Conjunctival Autograft was the only statistically significant vari-able.
- Fisher’s exact test, p=0.015; OR 7.08; 95% CI 1.60-31.33 - Multiple logistic regression analysis, p=0.028; OR 5.42; 95% CI 1.20-24.52)
Conclusion
• preoperative morphologic factors or adjunc-tive treatment did not affect the recurrence of the pterygium
• conjunctival autograft was significantly de-creased the risk of the reccurence of the pterygium