Results of Sutureless Autograft Transplantation in Primary Pterygium Surgery

Authors:

Leon-Cabello MJ, MD, PhD

Casal-Valino M, MD

Garcia-Hinojosa J, MD, PhD.The authors of this poster have reveived travel expense reimbursement from Company Bausch &Lomb and Company Pfizer.

Introduction - Purpose

• The prevalence of pterygium varies from 1.2% (in Caucasian populations and at a higher latitude) up to 30% (in tropical latitude, near the Equator).The key factor seems to be the induced damaged to the limbal stem-cells by more aggressive action of ultraviolet solar rays. (1) (2)

• The considerable increase in immigration from Latin America to Spain (with Ecuadorian population representing the largest minoriy) has had an effect on our daily clinical practise.

• The purpose of the study is to assess short and long term success and complications after glued conjunctival autograft transplantation in primary pterygium surgery as well as its relation to ethnicity.

Methods

• Retrospective study of 100 consecutive cases of primary pterygium surgery.

• A superior conjunctival autograft was harvested and attached onto bare sclera with a fibrin glue (3)after pterygium excision using topical plus subconjunctival anesthesia.

• In case of double-pterygium (nasal and temporal), a larger conjunctival graft was divided into two pieces.

• The mean follow-up was 136 days up to a maximum of 17 months.

• It was considered graft failure as an abscence of graft by the fourth week.It was considered recurrence as any growth of conjunctiva into the cornea.

Methods

Follow up Cases

< 1 Month 14

1 - < 3 Months 41

3 - < 6 Months 18

6 - < 9 Months 13

9 - < 12 Months 2

> 12 Months 12 Double Pterygium

Results

Complications Cases %

Recurrence rate 9 9%

Graft Failure 5 5%

Inclusion Cysts 3 3%

Dellen 1 1%

Diplopia 1 1%

Pterygium Recurrence

Inclusion Cyst

Results

• All of the recurrence cases were found in Latinos.• All of the double-pterygium cases were found in

Latinos.• There was a statistically significant difference in the

pterygium recurrence rate between the Latin American population (9%) and the Caucasian local Spanish population (0%) (p < 0.05).

• The average time to recurrence was 4.6 months (range, 2.2-11).

First Day of follow up after Conjunctival Autograft

Two months after conjunctival autograft

Results

Country Cases %

Spain 27 27%

Latin America

72 72%

Mali 1 1%

Total 100 100% Good Cosmetic Appearance after Conjunctival autograft

ResultsNationality * Cases %

Ecuador 46 46%

Spain 27 27%

Peru 12 12%

Bolivia 10 10%

Dominican Republic 2 2%

Venezuela 1 1%

Brazil 1 1%

Mali 1 1%

Total 100 100%*Source”: CIBELES: Centro Información Basica Estrategica para Los Entornos Sanitarios

ResultsEye- Pterygium Cases % Recurrent

Cases

OD- Simple 55 55% 6

OS- Simple 41 41% 2

OD- Double 2 2% 1

OS- Double 2 2% 0

Total 100 100% 9

Patient Age by Country

N Arithmethical

Mean

Standard Deviation

Spain 27 53.78 16.409

Others 73 39.0 9.713

Conclusions

• Conjunctival Autograft Transplantation provides better results among Caucasian local Spanish population where it seems to be a definitive treatment.

• Latin American ethnicity is a potencially important risk factor for recurrence of primary pterygium.

• No major complications have been found.

Bibliography

• (1) Arriola Villalobos, P. Epidemiología del Pterigium. In: Mª Teresa Iradier Urrutia. Cirugía del Pterigium. Sociedad Española de Oftalmología. 2006.45-95.

• (2) Kandavel R, Kang JJ, Memarzadeh F et al. Comparison of Pterygium Recurrence Rates in Hispanic and White Patients After Primary Excision and Conjunctival Autograft. Cornea 2010; 29:141-145) .

• (3) Uy HS, Reyes JMG, Flores JDG et al. Comparison of Fibrin glue and Sutures for Attaching Conjunctival Autograft after Pterygium Excision. Ophthalmology 2005; 112:667-671.

AcknowledgmentsTo Susana de Juan,MD, for her support with the statistical analysis

To Alejandro Aguirre, MD, for his unconditional help.

To the administrative team from Infanta Leonor Hospital for their help gathering data.