These various rates of recurrence have been attributed to different concentrations and patching times of the MMC cotton applicator, as well as to the surgical technique used. Also, basic science studies have shown that changes in the limbal stem cells and fibroblasts have a role in pterygium formation and pathogenesis.2,9. Currently,. Said DG, Faraj LA, Elalfy MS, Yeung A, Miri A, Fares U, et al. did not show an association between the fleshiness of pterygium and recurrence.18 They showed that eshiness of pterygium protected older patients from pterygium recurrence after excision, and they concluded that eshiness was not an important factor for the recurrence. Hovanesian J, Starr C, Vroman D, Mah F, Gomes J, Farid M, et al. Results: Keywords: Publication types Li J, OReilly N, Sheha H, Katz R, Raju VK, Kavanagh K, et al. The recurrence of pterygium after different modalities of surgical Marmamula S, Khanna RC, Rao GN. Wagdy FM, Farahat HG, Ellakwa AF, Mandour SS. Kampitak et al. Outcome of pterygium surgery: analysis over 14 years | Eye In general, the most important question regarding the surgical management of recurrent pterygium is choosing between AMT and CAU. To summarize the recent evidence regarding different aspects of pterygium recurrence. They suggested that CAU alone seems to be a proper surgical choice for the treatment of recurrent pterygia; however, combining it with AMT provides a good surgical alternative in cases where little conjunctival donor tissue is available.6 There is controversial evidence that LCAU is more effective than CAU for treatment of recurrent pterygium. Fifty patients were randomized into either sutured graft or glued graft groups. Kim KW, Park SH, Kim JC. Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. government site. Meta-analysis on the recurrence rates after bare sclera resection with In another recently published study, the clinical outcomes of surgery for recurrent pterygia using MMC, double AMT, and a large conjunctival flap were investigated.99 This retrospective case series by Monden et al. An MX, Wu KL, Lin SC. Safety and efficacy of fibrin glue versus vicryl sutures in recurrent pterygium with amniotic membrane grafting. Comparison of Pterygium Recurrence Rates Among Different : Cornea Human-based studies from PubMed, Scopus, and Google Scholar were identified using one or more of the following keywords: Conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management, pterygium surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, adjuvant therapy, risk factors, and predicting factors. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Therefore, a larger graft is needed to close this defect. Fakhry et al. Bayar SA, Kucukerdonmez C, Oner O, Akova YA. However, the recurrence rate is not clinically lower than control group, Single or multiple subconjunctival ranibizumab (0.5 mg/0.05 mL) injections within 6 months of recurrence diagnosis: 5 patients received 1 injection; 4 patients received 3 injections (basal, 2 and 4 weeks), Multiple injections did not appear to be superior to a single injection with regards to conjunctival hyperemia, Single subconjunctival bevacizumab (2.5 mg/0.1 mL) injection (0.5 mL), Subconjunctival bevacizumab injection is useful for the management of recurrent pterygium, Starting from 1 month after pterygium surgery with CAU: Subconjunctival bevacizumab (2.5 mg/0.1 mL) injection (mean injection 20.78), Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, Three subconjunctival bevacizumab (2.5 mg/0.1 mL) injections within 3 months of recurrence diagnosis: Basal, 2 and 4 weeks, This method was able to regress corneal and conjunctival neovascularization in early corneal recurrent pterygia, After pterygium surgery with bare sclera: 12 patients received bevacizumab eyedrops (0.05%) 4 times daily for 3 months; 10 patients received placebo only, Short-term topical bevacizumab helped with lowering the trend for recurrence, Three monthly subtenon ranibizumab (0.5-2 mg) injections within 3-18 months of recurrence diagnosis: Basal, 1 and 2 months, In half of the cases, the recurrent pterygium growth was arrested. In multiple studies, the surgical technique used for primary pterygium removal is proven as an important risk factor for pterygium recurrence. Li W, Lou Y, Wang B. In another study by Toker et al., patients were followed up for one year, as nearly all postoperative recurrences occurred within that time.12 This was in agreement with another study showing that 87.5% of recurrences happened in the first postoperative year.17 In a study using preserved limbal allograft and amniotic membrane transplantation (AMT) for recurrent pterygium by Ono et al., the results showed that the mean period to recurrence was 16.3 months (range, 533 months) after surgery.53 The authors reinforced that the recurrence rate in the previous studies would have been much higher if the follow-up period was long enough. Barbosa JB, De Farias CC, Hirai FE, Pereira Gomes J. The use of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium. PMID: 25320400 PMCID: PMC4196535 DOI: 10.4314/gmj.v48i1.6 Abstract Objectives: To determine the epidemiology and recurrence rate of pterygium after excision using bare sclera technique. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively ( ). though it carries with it an increased risk of pterygium recurrence . Summary of prospective studies on pterygium, covering the risk factors, different treatment options, and ways to improve the surgical outcomes and decrease the recurrence rate, *Superscript numbers are related cited reference numbers. New treatment options for pterygium. Incomplete postoperative inflammation control and uncontrolled UV light exposure can increase the risk of recurrence as well. . Relationship between angiogenesis and lymphangiogenesis in recurrent pterygium. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. Simple bare sclera resection alone has the highest rate of recurrence and was associated with 6 times higher odds of pterygium recurrence.10,52 Simple bare sclera excision is not encouraged as a method of primary pterygium removal in the current era.10 The recent meta-analysis published in Cochrane favored using CAU for participants with primary and recurrent pterygia to reduce recurrence at the first 6 months of follow-up.65 In the comparison of fixation of graft with sutures versus fibrin glue, graft retraction is the most common drawback when sutures are used.66 Therefore, using fibrin glue instead of sutures is another surgical modification. Shehadeh-Mashor R, Srinivasan S, Boimer C, Lee K, Tomkins O, Slomovic AR. They concluded that surgeon's preferences should determine the method of treatment.11 Lee et al.95 conducted a retrospective study to evaluate the efficacy and safety of pterygium excision using a large CAU for the treatment of recurrent pterygium. compared AMT to free CAU for the treatment of patients with recurrent pterygium. reported a long-term follow-up of preserved limbal allograft and AMT for recurrent pterygium in 84 eyes. Recurrent Pterygium Excessive exposure to outdoor condition such as ultraviolet radiation, drying and trauma from wind and dust has been proposed as the etiology of this conjunctival change Clinical Features Symptoms: Often asymptomatic or only cosmetic Rarely cause visual impairment evaluated the differences in tear film parameters between pterygium-affected and healthy eyes. Changes of tear film function after pterygium operation. One year later, about 2% of cases in the LCAU group in comparison to 11% of cases in the AMT group developed recurrence (P = 0.19). However, in some studies, AMT was compared with CAU without using intraoperative MMC. As there is no definite recommendation or guideline for use of adjuvant treatments, and future studies are needed to standardize dosage, time, and ways of administration. reported their finding on recurrent pterygium cases treated with AMT combined with 0.02% MMC for 1 min or CAU combined with the same dose of MMC.10 They found a similar recurrence rate in both groups. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: Clinical perspectives. included 31 eyes with recurrent pterygia and followed the patients for about 3.6 years. Pterygium recurrence time - PubMed Management of complicated multirecurrent pterygia using multimicroporous expanded polytetrafluoroethylene. Surgical techniques and adjuvants for the management of primary and recurrent pterygia. Comparison of efficacy of three surgical methods of conjunctival autograft fixation in the treatment of pterygium. They showed that pterygium is associated with tear hyperosmolarity and abnormal tear film function.79 Trkylmaz et al. Few studies before 2009 have investigated the effect of DED on pterygium recurrence. Younger age was associated with a significantly increased recurrence rate (P=0.002). Intraoperative techniques like tucking-in the amniotic membrane under the surrounding conjunctiva or pinching it together with the recipient conjunctiva have been suggested by some authors to achieve a good apposition.52,59. They concluded that LCAU with the additional widening of the limbal incision was more effective in terms of reducing pterygium recurrence than CAU alone. Purpose: To define the amount of time necessary to follow patients after pterygium removal to identify a recurrence. Comparison of fibrin glue with sutures for pterygium excision - PubMed 5-FU was adopted as a routine in the treatment of pterygium by some authors.8,15 In the Said et al. Zaky KS, Khalifa YM. It has been known that angiogenesis and vascular proliferation is a part of the pterygium pathogenesis.82 Several studies have shown that in the natural history of pterygium formation and recurrence, expression of basic fibroblast growth factor, VEGF, transforming growth factor-, and platelet-derived growth factor are increased.24,83,84 Before 2009, medical adjunctive approaches to prevent neovascularization and future recurrence of pterygium included therapy with beta radiation, MMC, 5-FU, and corticosteroids in routine practice.2,8,15 However, later, the value of anti-VEGFs was noticed by some authors, as these class of adjunct medications did not have significant ocular side effects like MMC or 5-FU.84,89 Therefore, in recent years, anti-VEGF agents such as bevacizumab and ranibizumab have been studied widely in primary and recurrent pterygium treatment as adjunctive therapy to surgical excision or as a nonsurgical treatment alone.58,85,86,87,88,89,90,91,92,93 Different routes and doses of administration have been evaluated in multiple studies. Using fibrin glue instead of sutures can further reduce recurrence rates. Kim KW, Kim JC. All four studies showed a lower pterygium recurrence rate in conjunctival or limbal autograft groups (P=0.05). Bahuva A, Rao SK. Long-term outcomes of conjunctivo-limbal autograft alone and additional widening of limbal incision in recurrent pterygia. However, fleshy appearance of the pterygium and preoperative size remain controversial. Here, a surgeon discusses ways to avoid it and what to do if the pterygium comes back. Different topical steroid regimens have been suggested to control inflammation after pterygium surgery; however, none of them has been confirmed.59 Hirst et al. The rationale for using intraoperative MMC after removal of the pterygium is its inhibitory effect on DNA replication, then slowing down fibrovascular tissue regrowth. Al Fayez MF. There are several studies which reported a recurrence rate of 0%4.5% with fibrin glue.12,40,67,68,69,70,71 Prospective randomized controlled studies showed lower long-term recurrence rates with fibrin glue in comparison to polyglactin or nylon sutures.12,67,70 It can be due to less postoperative inflammation and an immediate adherence of the graft, which plays a crucial role in inhibiting fibroblast ingrowth, encouraging earlier graft vascularization, and reducing the recurrence.19,66,72 Romano et al. demonstrated a reduction in recurrence rate by 50% through additionally applying lubricant eye drops after steroid drops instillation for a postoperative period of 3 months, highlighting the importance of an adequate ocular surface problems management following pterygium resection.75 They concluded that using artificial tears as adjunctive drug to topical corticosteroid could lower the risk of pterygium recurrence. In half of the eyes, multi-microporous e-PTFE was inserted between the transplanted amniotic membrane and the conjunctiva intraoperatively. Zhang LW, Chen BH, Xi XH, Han QQ, Tang LS. ASCRS Cornea Clinical Committee. Subconjunctival and topical application are the most popular administration techniques. In addition, nonsurgical and surgical alternatives for management of recurrence are discussed. Results: 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). found that carriers of BRAFV600 mutation had an 8-fold increased risk of recurrence during the first year after pterygium surgery.31 In addition, viruses such as HSV, EBV, CMV, and HPV can be other risk factors for recurrence.31, It was known from the earliest reports that the incidence of pterygium is higher in areas closest to the geographical equator, which was considered due to the effect of UV light.2 Previous studies have not found gender among the proven nonsurgical risk factors for recurrence.28 However, younger age was found to be associated with a higher risk of recurrence, and patients under the age of 45 have a 3.5-fold increase in their risk of recurrence.17,28 Possible explanations for higher recurrence in younger subjects are rapid re-epithelialization, aggressive collagen synthesis, rapid angiogenesis, more robust and vigorous inflammatory response, and increased outdoor activity with high exposure to the dusty atmosphere and UV light.17,28,32, In addition, preoperative ocular surface inflammation is associated with higher postoperative recurrence rates.28 Therefore, ocular surface inflammation has a significant role in pterygium recurrence, and early clinical recognition of factors leading to pre or postoperative inflammation with the application of appropriate treatment is recommended.33,34 Ocular demodicosis is another strong perpetuating factor for increased ocular surface inflammation in association with chronic blepharitis, blepharoconjunctivitis, rosacea blepharitis, meibomian gland dysfunction, and keratitis.20,35,36,37 In a retrospective study done by Huang et al., ocular demodicosis is introduced as an overlooked risk factor for pterygium recurrence.20 Although previous studies have not shown gender as the main risk factor for recurrence,28 Huang et al. "If a pterygium comes back, it's a real problemit can be worse than the first occurrence. Zein H, Ismail A, Abdelmongy M, Elsherif S, Hassanen A, Muhammad B, et al. In conclusion, to evaluate pterygium recurrence properly, the postoperative follow-up assessment should be at least 12 months.8,11,17 It has been noticed that most recurrences occur within the first 36 months after surgery.28, Some researchers believe that if later recurrences are taken into account, there may be a significantly greater recurrence rate than previously reported.17 There are studies with a median follow-up of 12 years51 or even up to 18 years.43 Kucukerdonmez et al. 3 - 7 According to a meta-analysis of 20 studies published in 2015, the pooled prevalence of pterygium is around 10%. Ozgurhan EB, Agca A, Kara N, Yuksel K, Demircan A, Demirok A. Topical application of bevacizumab as an adjunct to recurrent pterygium surgery. Monitoring the patients closely after a single injection to repeat the injection in cases with the minimal response is recommended. Comparison of pterygium recurrence rates after limbal - PubMed Recurrent Pterygium | Vagelos College of Physicians and Surgeons Mai W, Chen M, Huang M, Zhong J, Chen J, Liu X, et al. Pan HW, Zhong JX, Jing Cx. Impaired vision, induced astigmatism, and recurrent inammation are among common complications. Julio G, Lluch S, Pujol P, Alonso S, Merindano D. Tear osmolarity and ocular changes in pterygium. How to minimize pterygium recurrence rates: clinical perspectives Fibroblast biology in pterygia. evaluated 51 studies and confirmed this finding in an Ophthalmic Technology Assessment paper.15 Most of the published studies have used MMC with a range of 0.01%0.04% intraoperatively. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. The site is secure. compared the outcomes of an LCAU with AMT followed by intraoperative 0.02% MMC to treat recurrent pterygium. Pterygium is a common ocular surface disorder. showed that augmenting CAU with Ologen implantation is effective in the management of recurrent pterygium with mild nonvision-threatening postoperative side effects comparable to that of MMC.63 It should be noted that a combination of different adjunct therapies is much better than single adjunct therapy in reducing the rate of recurrence.64. Nava-Castaeda A, Ulloa-Orozco I, Garnica-Hayashi L, Hernandez-Orgaz J, Jimenez-Martinez MC, Garfias Y. Pterygium: an update on pathophysiology, clinical features, and
Portland, Maine Zen Center, Gsc Women's Basketball Standings, Articles P