Impact of conjunctival autograft on pterygium treatment: evaluation of related symptoms and patients' satisfaction after surgery

Abstract

Purpose: Pterygium is a fibrovascular condition of the ocular surface that can cause a broad range of irritative and visual symptoms. Controversy exists regarding pterygium mechanisms, management, surgical techniques, adjuvant approaches and impact on patients' quality of life. We performed a retrospective survey focused on the impact of pterygium-related symptoms before surgery and patients' satisfaction after excision surgery followed by conjunctival autograft transplantation with fibrin glue, based on patients' subjective reporting.

Methods: All patients underwent surgery consisting of the extensive removal of the pterygium fibrovascular tissue, followed by autologous conjunctival graft fixed with fibrin glue to cover the bare scleral area. A total of 500 patients were contacted by phone call and invited to participate in the study answering a brief two-question survey. First, to grade overall intensity of symptoms related to pterygium before surgical intervention, such as pain, irritation, tearing, red eye, photophobia, burning and foreign body sensation, using a scale from 0 to 10 (0 asymptomatic and 10 very severe symptoms). Results were categorized as mild (0-3), moderate (4-7) and severe (8-10). Then, patients were asked about their satisfaction with the surgery outcome, also using a scale from 0 to 10 (ranging from dissatisfied to fully satisfied).

Results: Patients' mean age was 41.5±12.31 (min 18/max 83) years old and the mean of days after surgery was 1,493±552.7 (min 711/max 2,702). Symptoms were referred to as severe (70.2%), moderate (25.2%) and mild (4.6%). After surgery, most patients were fully satisfied and the mean grade was 9.6; 1% (0-3), 2.4% (4-7) and 96.6% (8-10). Women presented a higher score of symptoms compared to men (P<0.01) but similar satisfaction rates.

Conclusions: The present study shows that pterygium greatly impacts on patients' quality of life and that excision surgery using conjunctival autograft transplantation and fibrin glue improved symptoms with high rates of satisfaction.

Keywords: autologous conjunctival graft; fibrin glue; pterygium; quality of life; surgery; symptoms.

Figure 1

Illustrative example of surgical technique: pterygium removal followed by conjunctival autograft with fibrin glue fixation (A) before surgery, and (B) final appearance.

Figure 2

Illustrative example of final ocular surface appearance 3 months after pterigyum removal and autologous conjuntival graft. No recurrence.

Figure 3

Overall scores for preoperative symptoms (A) and postoperative satisfaction (B).

Figure 4

Preoperative symptoms (A) and postoperative satisfaction (B) according to sex.