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Meta-Analysis
. 2017 Oct:182:8-17.
doi: 10.1016/j.ajo.2017.07.004. Epub 2017 Jul 19.

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Elizabeth Clearfield  1 , Barbara S Hawkins  2 , Irene C Kuo  3
Affiliations
Meta-Analysis

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Elizabeth Clearfield et al. Am J Ophthalmol. 2017 Oct.

Abstract

Purpose: To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium.

Design: Cochrane systematic review.

Methods: We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis.

Results: Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33-0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21-0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs).

Conclusions: CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.

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Figures

Figure 1
Figure 1
Identification and selection of trials that compared conjunctival autograft with amniotic membrane transplantation for pterygium.
Figure 2
Figure 2
Risk of bias for individual trials by domain assessed. Green, low risk of bias; yellow, unclear/unknown risk of bias; red, high risk of bias.
Figure 3
Figure 3
Forest plot showing estimated risk ratios (RRs) with their 95% confidence intervals (CIs) for recurrence of pterygium 3 months after surgery
Figure 4
Figure 4
Forest plot showing estimated risk ratios (RRs) with their 95% confidence intervals (CIs) for recurrence of pterygium 6 months after surgery
See this image and copyright information in PMC

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