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. 2011 Oct;25(4):411-5.
doi: 10.1016/j.sjopt.2010.10.013. Epub 2010 Oct 25.

The recurrence of pterygium after different modalities of surgical treatment

Abdelrahman G Salman  1 , Dina Ezzat Mansour
Affiliations

The recurrence of pterygium after different modalities of surgical treatment

Abdelrahman G Salman et al. Saudi J Ophthalmol. 2011 Oct.

Abstract

Purpose: To assess and compare the recurrence rate of pterygium after limbal stem cell transplantation versus amniotic membrane transplantation (AMT) as ocular surface reconstructing measures in recurrent pterygium, also evaluation of the use of antimetabolite drugs as adjunctive therapy for AMT.

Patients and methods: Prospective randomized comparative study included 60 eyes of 48 patients with recurrent pterygia. Informed consents were taken from all patients. Primary pterygium excision was performed 6-15 months ago; the cases were divided randomly into three equal groups: Group 1: included 20 eyes with excision of the pterygium and application of limbal stem cell transplantation with conjunctival autograft, group 2: included 20 eyes with excision of the pterygium followed by AMT and group 3: included 20 eyes in which surgical excision of pterygium was followed by intra-operative application of low-dose of MMC (0.05%) for 3 min then using AMT.

Results: The study included 36 males and 12 females of age ranged from 28 to 52 years. The recurrence rate was 2 eyes in group 1 (10%) (limbal stem cell transplantation + conjunctival autograft), 6 eyes in group 2 (30%) (AMT) and 4 eyes (20%) in group 3 (MMC + AMT). The rate of recurrence was significantly different between the three groups (P < 0.001).

Conclusions: Limbal stem cell transplantation together with conjunctival autografting proved to be more effective in prevention of pterygium recurrence and in rapid restoration of normal epithelial morphology. MMC in addition to AMT decreases the incidence of recurrence.

Keywords: AMT, amniotic membrane transplantation; Amniotic membrane transplantation; Impression cytology; MMC, mitomycin C; Mitomycin C; Ocular surface diseases; Recurrent pterygium; Stem cells autograft.

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Figures

Figure 1
Figure 1
Top (patient of group 1) – top left: recurrent pterygium and top right: 6 months after limbal autograft. Bottom (patient of group 3) – AMT + MMC after pterygium excision.
Figure 2
Figure 2
Steps of AMT (patient of group 2).
Figure 3
Figure 3
Top left: Cytological changes of recurrence; top right: conjunctival granuloma. Down left: Stage II squamous metaplasia; down middle: stage I squamous metaplasia; down right: stage III squamous metaplasia.
Figure 4
Figure 4
Graph showing comparison of the recurrence incidence in the three groups. Showing highest recurrence with AMT and least recurrence with limbal stem cell transplantation.
See this image and copyright information in PMC

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