Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery

AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes(15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age 【40y [P =0.085, odds ratio(OR) 3.609, 95% confidence interval(CI) 0.838-15.540]and amniotic membrane graft instead of conjunctival autograft(P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence.Multivariate analysis revealed that intraoperative mitomycin C(MMC)(P =0.072, OR 0.298, 95% CI 0.080-1.115)decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation(AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.

Perioperative care following strabismus surgery for the patient with severe congenital neutropenia

A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The patient was being treated with G-CSF (Leufokine?) due to her severe congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it. Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery, profuse irrigation with the entire bottle of topical antibiotics (Vigamox?, moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed topical and highly potent systemic antibiotics for 1 week. This is the first case report to describe the successful perioperative antisepsis care following strabismus surgery for a patient with severe congenital neutropenia. Prevention of postoperative infection in granulocytopenic patients could be achieved using antibiotic agents which provide the greatest spectrum of coverage against both Gram-positive and Gram-negative infections.