Campagna Giovanni, Adams Matthew, Wang Li, Khandelwal Sumitra, Al-Mohtaseb Zaina
School of Medicine, Baylor College of Medicine, Houston, TX.
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX.
Cornea. 2018 Feb;37(2):199-204. doi: 10.1097/ICO.0000000000001453.
To evaluate the impact of race and ethnicity, surgical technique, and level of surgeon training on recurrence rates after primary pterygium excision.
A retrospective review of patients who underwent primary pterygium excision at our academic institution was performed. The surgical technique-conjunctival autografting (CAG) or amniotic membrane grafting (AMG)-was chosen at the attending surgeon's discretion, and all surgeries were performed by surgeons in training. The primary outcome measure was pterygium recurrence, defined as regrowth of fibrovascular tissue onto a clear cornea in the region of previous pterygium removal.
There was a significant difference in age at presentation between white (64.3 ± 11.4), Hispanic (50.0 ± 13.5), black (64.8 ± 14.5), and Asian (59.3 ± 9.2) patients (P < 0.001). Average time to recurrence was 4.4 ± 3.0 months and was similar between races (P = 0.98). There was a significant difference in recurrence rates between the white (13%), Hispanic (28%), black (33%), and Asian (0%) patients (P = 0.049). Over 12 months, a significant difference in cumulative proportion with recurrence after AMG versus CAG was observed in Hispanic (75% vs. 30%; P = 0.002) and black (100% vs. 42%; P = 0.001) patients. Sex, method of graft fixation (glue, suture, or both), and level of surgeon training showed no difference in pterygium recurrence (P > 0.05).
Hispanic and black patients are more likely to experience pterygium recurrence after AMG than CAG. White patients are less likely than Hispanic or black patients to experience recurrence regardless of the surgical technique. To reduce the likelihood of recurrence, surgeons may consider race and ethnicity when selecting their operative technique.
评估种族和族裔、手术技术以及外科医生培训水平对原发性翼状胬肉切除术后复发率的影响。
对在我们学术机构接受原发性翼状胬肉切除术的患者进行回顾性研究。手术技术——结膜自体移植（CAG）或羊膜移植（AMG）——由主刀医生自行决定，所有手术均由实习外科医生进行。主要观察指标是翼状胬肉复发，定义为在先前翼状胬肉切除区域的透明角膜上出现纤维血管组织再生。
白人（64.3±11.4岁）、西班牙裔（50.0±13.5岁）、黑人（64.8±14.5岁）和亚洲（59.3±9.2岁）患者在就诊时的年龄存在显著差异（P<0.001）。平均复发时间为4.4±3.0个月，各种族之间相似（P = 0.98）。白人（13%）、西班牙裔（28%）、黑人（33%）和亚洲（0%）患者的复发率存在显著差异（P = 0.049）。在12个月内，观察到西班牙裔（75%对30%；P = 0.002）和黑人（100%对42%；P = 0.001）患者中，AMG与CAG术后复发的累积比例存在显著差异。性别、移植固定方法（胶水、缝线或两者皆用）以及外科医生培训水平在翼状胬肉复发方面无差异（P>0.05）。
与CAG相比，西班牙裔和黑人患者在接受AMG后更易出现翼状胬肉复发。无论采用何种手术技术，白人患者比西班牙裔或黑人患者复发的可能性更小。为降低复发可能性，外科医生在选择手术技术时可考虑种族和族裔因素。
