The Eye Foundation, Coimbatore, India.
Rom J Ophthalmol. 2024 Apr-Jun;68(2):108-113. doi: 10.22336/rjo.2024.21.
To explore various approaches in the management of pterygium and to propose a simplified treatment algorithm for its surgical management. A retrospective analysis of 9219 eyes was done. Group I included patients with primary single-head pterygium, most undergoing pterygium excision with conjunctival autograft (CAG). CTG-P (Conjunctival tissue graft from pterygium), AMG (Amniotic membrane graft), and inferior CAG were done in the remaining patients in this group in which conventional conjunctival autograft was a relative contraindication. Group II included patients with primary double-head pterygium who underwent vertical/horizontal split CAG, with/without limbal orientation, Inferior + Superior CAG, CTG-P, and CAG + CTG-P. Group III included patients with recurrent single-head pterygium who underwent ER (Extended resection) + LCAG (Limbal conjunctival autograft), LCAG + MMC (Mitomycin-C), CAG + MMC (Mitomycin-C) and CAG. Group IV included patients with recurrent double-head pterygium who underwent split LCAG and CAG + SLET. All the four groups reported a low incidence of pterygium recurrence. Recurrence was observed at a rate of 0.47%, 3.63%, 2.86%, and 7.69% in Group I, Group II, Group III and Group IV respectively. We mainly aimed to get minimal recurrence and good cosmetic outcomes. In double-head pterygium, we could achieve good and comparable outcomes with horizontal or vertical split CAG, with or without maintaining limbal orientation. Similarly, Inferior + Superior CAG, CTG-P, CAG+CTG-P, and AMG also showed low recurrence rates. In recurrent pterygium, ER + LCAG/CAG, with/without adjuncts like MMC showed low recurrence rates. Thus, all of these methods were found to be viable options. The main strength of our study, compared to previous studies on pterygium was its large sample size and long duration of follow-up. All the methods we studied had a low recurrence rate. We have formulated a treatment algorithm for pterygium management based on our outcomes. CAG = Conjunctival autograft, CTG-P = Conjunctival tissue graft from pterygium, ER = Extended resection, MMC = Mitomycin-C.
为了探索翼状胬肉管理的各种方法，并提出一种简化的手术治疗方案。对 9219 只眼进行了回顾性分析。I 组包括原发性单头翼状胬肉患者，大多数患者行翼状胬肉切除术联合结膜自体移植（CAG）。在常规结膜自体移植相对禁忌的患者中，行 CTG-P（翼状胬肉体组织移植）、AMG（羊膜移植）和下方 CAG。II 组包括原发性双头翼状胬肉患者，行垂直/水平分裂 CAG，带/不带角膜缘取向，下方+上方 CAG、CTG-P 和 CAG+CTG-P。III 组包括复发性单头翼状胬肉患者，行 ER（广泛切除）+LCAG（角膜缘结膜自体移植）、LCAG+MMC（丝裂霉素 C）、CAG+MMC（丝裂霉素 C）和 CAG。IV 组包括复发性双头翼状胬肉患者，行分裂 LCAG 和 CAG+SLET。所有四组患者翼状胬肉复发率均较低。I 组、II 组、III 组和 IV 组的复发率分别为 0.47%、3.63%、2.86%和 7.69%。我们主要旨在获得最小的复发率和良好的美容效果。在双头翼状胬肉中，我们可以通过水平或垂直分裂 CAG 实现良好且可比的结果，无论是否保持角膜缘取向。同样，下方+上方 CAG、CTG-P、CAG+CTG-P 和 AMG 也显示出较低的复发率。在复发性翼状胬肉中，ER+LCAG/CAG，联合/不联合 MMC 等辅助治疗，复发率较低。因此，所有这些方法都被认为是可行的选择。与以前的翼状胬肉研究相比，我们研究的主要优势是样本量大且随访时间长。我们研究的所有方法复发率均较低。我们根据研究结果制定了翼状胬肉管理的治疗方案。CAG=结膜自体移植，CTG-P=翼状胬肉体组织移植，ER=广泛切除，MMC=丝裂霉素 C。
