Z-shaped incision without epithelial resection in pterygium surgery

AIM:To introduce a novel surgical technique using a Z-shaped incision without epithelial resection in ophthalmic pterygia.METHODS:This was a prospective study.During pterygium surgery,all proliferative tissues were separated from the cornea and conjunctiva without resection of the tissues.The unaffected conjunctiva was incised in a Z-shape.The upper(or lower)conjunctival flap was sutured to the lower(or upper)normal conjunctiva on the limbal sclera,while the proliferative tissue was sutured to the upper conjunctiva(or lower)near the fornix.RESULTS:Ten patients with pterygia were eligible for this study.Eight patients with primary pterygia and 2 with recurrent pterygia were included.The age of patients at surgery ranged from 47 to 90y(average:71.9y).Five patients each showed right and left-sided pterygia.The postoperative follow-up periods were from 8 to 78mo(average:25.0mo).The surgery was successfully conducted and wounds were favorably reconstructed in all patients.The proliferative tissues sutured to the normal conjunctiva showed palor and attenuated neovessles,and never showed re-growth after surgery.Nine patients did not show recerrence.Recerrent pterygium was noted in 1 patient,but additional treatments were not required.CONCLUSION:The procedure involves the reconstruction of pterygial tissue and normal conjunctiva using a Z-shaped incision.The scleral limbal wound can be covered with nonaffected conjunctiva without any excision of conjunctival epithelia in patients with primary or recurrent pterygia.

Cosmetic outcome of femtosecond laserassisted pterygium surgery

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4:excellent-poor).Weighted Cohen's kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6 months(1.0±0.0)and 12 months(1.0±0.0)postoperatively.At final fllow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(k:0.86-0.95)and inter-rater reliability(k:0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathinCAG.Trial registration:ClinicalTrials.gov,NCT02866968.Registered in July 2016.

Cosmetic outcome of femtosecond laserassisted pterygium surgery

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4=excellent-poor).Weighted Cohen’s kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6months(1.0±0.0)and 12months(1.0±0.0)postoperatively.At final follow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(κ=0.86-0.95)and inter-rater reliability(κ=0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathin CAG.

Mitomycin C in pterygium treatment

Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea.Most cases of pterygium does not cause problem or requires specific treatment.The exact cause of pterygium is not clear yet,but some factors are pointed as causes,being the most important the long-term ultraviolet ray exposure.Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment.Recurrence is the main complication of the surgery,and much has been done to avoid it.Mitomycin C（MMC） has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium.This review describes the use of MMC as an adjunctive,the optimal dosage,the duration of administration of MMC and possible complications,when used during,after and before the surgery.Most studies suggest that increased exposure（dose or duration） of MMC is associated with a lower recurrence,but with higher risks of complications.