Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Sati A, Shankar S, Jha A, Kalra D, Mishra S, Gurunadh VS. MMC was used as an adjuvant in both groups. 8600 Rockville Pike 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. This emphasizes the importance of early administration of these drugs. Tear osmolarity showed deterioration in patients with pterygium recurrence. 10-year incidence and associations of pterygium in adult Chinese: The Beijing Eye Study. The overall recurrence rate was 34.5% (19/55 cases). Immunohistochemical analysis of vascular endothelial growth factor (VEGF) and p53 expression in pterygium from Tunisian patients. In multiple studies, the surgical technique used for primary pterygium removal is proven as an important risk factor for pterygium recurrence. The main treatment for pterygium is surgical removal. This was true also for participants with recurrent pterygium.65 Considering the 3-month rate of pterygium recurrence using each technique for both primary and recurrent pterygium, the recurrence rate ranged from 0% to 16.7% in the CAU and 4.76% to 26.9% in the AMT group.65 There was a substantial reduction in the risk of recurrence for participants with recurrent pterygium who received CAU surgery in comparison to AMT surgery. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Monitoring the patients closely after a single injection to repeat the injection in cases with the minimal response is recommended. Liang L, Safran S, Gao Y, Sheha H, Raju VK, Tseng SC. Results. Rest assured, pterygium is a benign (non-cancerous) lesion that does not spread beyond the surface of the eye. Results This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). official website and that any information you provide is encrypted 1Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, 2Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, 3Department of Radiation Oncology, Indiana University, Indiana, USA, 4Alavi Eye Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. They showed that surgical pterygium excision with the application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia.99 The same team later published their results of surgery on 10 eyes with recurrent pterygium and severe symblepharon using the same technique with addition of cryopreserved limbal allograft transplantation and found the final results to be promising.100 Expanded polytetrafluoroethylene (e-PTFE), known as Gore-Tex, is a fluoropolymer that can prevent adhesion of the wound area to adjacent tissues and promote epithelialization. AMT combination with CAU after pterygium removal decrease the chance of postoperative inflammation and thereby, the recurrence rate.52 This effect is likely due to rapid epithelialization of the amniotic membrane. Ultraviolet light and ocular diseases. Multiple weekly subconjunctival intralesional 5-FU injections were shown to be safe and effective in halting the progression and inducing regression of recurrent pterygium.19 Topical bevacizumab was found to inhibit growth of impending recurrent pterygium, but the effect was mostly temporary and just delayed the recurrence. Qi CX, Zhang XD, Yuan J, Yang JZ, Sun Y, Wang T, et al. 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. As a library, NLM provides access to scientific literature. 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. The preventive considerations are generally categorized as medical methods (mitomycin C [MMC] application) or surgical methods (CAU, AMT).58, It was proposed initially that pterygium is a chronic degenerative process and its removal activates subconjunctival fibroblasts, inducing the proliferation of fibroblasts and vascular cells. showed that all recurrences occurred within 1 year after surgery.52 They found that the meantime to recurrence in the fibrin glue treated group was not significantly different from the suture group (6.3 vs. 7.6 months). The rationale for using intraoperative MMC after removal of the pterygium is its inhibitory effect on DNA replication, then slowing down fibrovascular tissue regrowth. Among nonsurgical methods, injection of 5-FU and anti-VEGFs has become popular in recent years. Monden Y, Nagashima C, Yokote N, Hotokezaka F, Maeda S, Sasaki K, et al. Pterygium, from the Greek pterygos meaning "wing", is a common ocular surface lesion originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea. Therefore, it is better to use it in combination with CAU. Mahar P, Manzar N. Risk factors involved in pterygium recurrence after surgical excision. Fakhry MA. Kampitak K, Leelawongtawun W. Precorneal tear film in pterygium eye. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. The results showed that there is no difference in the recurrence rate and cosmetic outcomes between groups. Zhang LW, Chen BH, Xi XH, Han QQ, Tang LS. Bethesda, MD 20894, Web Policies Recurrence rates following bare sclera resection range from 24% to 89%, 10-12 following bare sclera resection with mitomycin application between 0% and 38%, 3-5 11 and following pterygium resection with conjunctival graft placement between 2% and 39%. Zhao L, You QS, Xu L, Ma K, Wang YX, Yang H, et al. Many authors believe that 97% of recurrences after surgery happen within the first 12 months.6,31,52,53,54,55,56, The same protective measures recommended for the avoidance of development of primary pterygium, like sunlight, wind, and dust, wear UV light protecting sunglasses and hats, may prevent recurrence of pterygium. It's best to approach pterygium surgery with the goal of reducing the chances of recurrence at all costs. There is controversial evidence that LCAU is more effective than CAU for the treatment of recurrent pterygium. Expression and role of specificity protein 1 and collagen I in recurrent pterygial tissues. Simple limbal epithelial transplantation for recurrent pterygium: A case series. Zein H, Ismail A, Abdelmongy M, Elsherif S, Hassanen A, Muhammad B, et al. This might be also due to the higher rates of ocular demodicosis in male patients.20 African-Americans are also at increased risk of recurrence.28, Pterygium characteristics and surgical techniques. 3 - 7 According to a meta-analysis of 20 studies published in 2015, the pooled prevalence of pterygium is around 10%. Therefore, long-term evaluation after surgery is necessary in cases treated by MMC. government site. Hall RC, Logan AJ, Wells AP. Concerning the time of recurrence, although most recurrences happen in the first 36 months after surgery, there is no clear cut-off period for recurrence, and it can occur even after many years.28 It is recommended that studies, which aim to evaluate the recurrence, should consider their follow-up period at least 1 year. Rykov SO, Usenko KO, Mogilevskyy S, Ziablitsev SV, Denisiuk LE. Katrcoglu YA, Altiparmak U, Engur Goktas S, Cakir B, Singar E, Ornek F. Comparison of two techniques for the treatment of recurrent pterygium: Amniotic membrane vs conjunctival autograft combined with mitomycin C. Chen R, Huang G, Liu S, Ma W, Yin X, Zhou S. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: A randomized controlled trial. compared AMT to free CAU for the treatment of patients with recurrent pterygium. Moreover, recurrent pterygium cases are more challenging and should be approached with more accurate knowledge than primary pterygium cases because of their invasive nature. Mushtaq et al. Toker E, Eraslan M. Recurrence after primary pterygium excision: Amniotic membrane transplantation with fibrin glue versus conjunctival autograft with fibrin glue. Rural region of habitation, lower fasting blood glucose, LCAU is superior to CAU in recurrent pterygium surgery, Early graft retraction, ocular surface inflammation, Fibrin glue instead of suture, CAU is superior to AMT, LCAU combined with MMC results in a better cosmetic appearance and lower recurrence, 2 months after pterygium surgery with bare sclera and MMC: Topical bevacizumab eyedrops (25 mg/mL) 4 times daily for 3 weeks, Topical bevacizumab may be effective to prevent recurrence in a patient with impending recurrent pterygium, After pterygium surgery with bare sclera and MMC: 26 patients received bevacizumab eyedrops (5 mg/ml) twice daily and betamethasone eyedrops 4 times daily for 1 week; 28 patients received betamethasone only, Short-term topical bevacizumab helped with delaying the onset of recurrence in cases of impending recurrent pterygium, A single intralesional injection of bevacizumab in impending recurrent pterygium: 20 patients received 1.25 mg; 20 patients received 2.50 mg; 20 patients received 3.75 mg; 20 patients served as control, A single subconjunctival bevacizumab injection decreased conjunctival vascularization in a dose-dependent manner partially and transiently. Your eye doctor makes a formal diagnosis following a slit-lamp examination that allows close-up observation of the lesion under magnification. Khalfaoui T, Mkannez G, Colin D, Imen A, Zbiba W, Errais K, et al. Sarnicola V, Vannozzi L, Motolese PA. showed that the use of fibrin glue in pterygium surgery with AMT was safer, less toxic, and less time-consuming and resulted in fewer complications than graft surgery with sutures.96 Therefore, fibrin glue can further reduce recurrence rates and surgery time. Kampitak and colleagues have been publishing multiple studies regarding the ocular surface changes in pterygium patients pre and postoperatively. Incomplete postoperative inflammation control and uncontrolled UV light exposure can increase the risk of recurrence as well. Stival LR, Lago AM, Figueiredo MN, Bittar RH, Machado ML, Nassaralla Junior JJ. 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. Reda et al. Simple excision of primary pterygia is associated with a high recurrence rate (33-45%). Metrics Abstract Aim To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. Hirst LW. Methods: A retrospective review of patients who underwent primary pterygium excision at our academic institution was performed. Pterygium is an abnormal growth of epithelial and fibrovascular tissue invading toward cornea. Hirst introduced a variation to the standard CAU technique in 2009. To treat the pterygium, surgical excision is one of the commonly used methods, but the recurrence rate can be high after its surgical removal . and transmitted securely. 126 Some studies compared results . Conclusions: According to the current evidence from literature, recurrence rates after pterygium excision with LCAG are lower when compared with the use of bare sclera, bulbar conjunctival autograft, or intraoperative mitomycin C. Evaluation of conjunctival autografting augmented with mitomycin C application versus ologen implantation in the surgical treatment of recurrent pterygium. "That's not a . DED perpetuates ocular surface inflammation in the postoperative period, and this inflammation may increase the rate of recurrence.14,77 Proper and early diagnosis and management of DED in the perioperative period could reduce the risk of recurrence.14,34. Therefore, later authors look for an adjacent procedure/medication that could increase the success rate of using AMT for the treatment of recurrent pterygia.6,10,11,15, Due to a larger area of subconjunctival fibrosis in some cases, a larger conjunctival defect is created after the excision of recurrent pterygium. Pterygium surgery is a minimally invasive procedure performed to remove benign conjunctiva growths (pterygia) from the eye. Farid M, Pirnazar JR. Pterygium recurrence after excision with conjunctival autograft: A comparison of fibrin tissue adhesive to absorbable sutures. It is important to consider the side effects associated with adjuvant treatment and make the final decision based on the benefit-risk ratio for each patient. Rose L, Byrd JM, Qaseem Y. Subtenon injections of ranibizumab arrest growth in early recurrent pterygium. Kim KW, Park SH, Kim JC. Kampitak K, Leelawongtawun W, Leeamornsiri S, Suphachearaphan W. Role of artificial tears in reducing the recurrence of pterygium after surgery: A prospective randomized controlled trial. Safety and efficacy of fibrin glue versus vicryl sutures in recurrent pterygium with amniotic membrane grafting. Huang Y, He H, Sheha H, Tseng SC. Recurrence is the most common complication after pterygium excision. 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. did not find a positive association between histology and recurrence.28 In addition, they could not find any significant difference in inflammation intensity, degree of vascularization, or fibrinoid change between the primary pterygium and the recurrent pterygium group. We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Study to correlate clinical and histopathological characteristics of pterygium in predicting its recurrence. Kasetsuwan N, Reinprayoon U, Satitpitakul V. Prevention of recurrent pterygium with topical bevacizumab 0.05% eye drops: A randomized controlled trial. exas in the years 2008 to 2019. Recurrent pterygia are more difficult to remove because of the scarring from the previous surgery. Varssano D, Shalev H, Lazar M, Fischer N. Pterygium excision with conjunctival autograft: True survival rate statistics. All four studies showed a lower pterygium recurrence rate in conjunctival or limbal autograft groups (P=0.05). Intraoperative MMC treatment is commonly applied to reduce the recurrence of pterygium [16, 33]. Kucukerdonmez C, Karalezli A, Akova YA, Borazan M. Amniotic membrane transplantation using fibrin glue in pterygium surgery: A comparative randomized clinical trial. Management of recurrent pterygium with intraoperative mitomycin C and conjunctival autograft with fibrin glue. evaluated the differences in tear film parameters between pterygium-affected and healthy eyes. 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. It has been documented that the use of AMT alone had a higher recurrence rate than the use of CAU alone in cases of surgery for recurrent pterygium. They found that the implantation of multi-microporous e-PTFE led to significantly lower recurrence rates (3.3% vs. 25%), also reduced symblepharon, motility restriction, and even hyperemia. . Subconjunctival and topical application are the most popular administration techniques. Design: Prospective non-comparative study. Several small studies have been performed to evaluate the role of perioperative 5-FU with or without concomitant corticosteroids in the management of recurrent pterygium since 2001.19,64 The initial results have been promising. Therefore, the exact time of pterygium recurrence cannot be accurately calculated as most patients are followed up for only 1 year and it may not be long enough in some eyes. Zloto O, Rosen N, Leshno A, Rosner M. Very long term success of pterygium surgery with conjunctival graft. Comparison of primary versus recurrent pterygium after intralesional 5-fluorouracil. Shehadeh-Mashor R, Srinivasan S, Boimer C, Lee K, Tomkins O, Slomovic AR. between intraoperative and postoperative appli- Assessment of fibrin glue in pterygium surgery. Katircioglu et al. study, multiple weekly subconjunctival intralesional 5-FU injections, 0.10.2 ml (2.55.0 mg) started within 1 month of recurrence, have been shown to be safe and effective in halting the progression and inducing regression of recurrent pterygium.19 Another study assessed the changes in pathological parameters of the ocular surface before and after 10 intralesional injections of 5-FU in recurrent pterygium cases.49 They reported an increase in the number of epithelial cells and density of goblet cells, reduction in the squamous metaplasia, and changing in abnormal cytology to normal in these injected eyes. Yam JC, Kwok AK. Pterygium is an abnormal growth of epithelial and fibrovascular tissue invading the cornea across the limbus and can lead to impaired vision (due to excessive dimensions or induced astigmatism) or recurrent inflammation. Bayar SA, Kucukerdonmez C, Oner O, Akova YA. Hovanesian J, Starr C, Vroman D, Mah F, Gomes J, Farid M, et al. The primary outcome measure was pterygium recurrence, defined as regrowth of fibrovascular tissue onto a clear cornea in the region of previous pterygium removal. found no connection regarding the abnormal expression of p53 with recurrence.28 Another molecular biomarker under investigation is vascular endothelial growth factor (VEGF) which has been introduced responsible for pterygium recurrence.29 It has been documented that the expression of VEGF receptor 2 (VEGFR-2) may have a predictive value in the recurrence of pterygium.30, Familial cases of pterygium have been reported and indicate that genetic factors are significantly involved in the pathogenesis of the primary disease.1 Rykov et al. 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. 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). Tear osmolarity and tear film parameters in patients with unilateral pterygium. MMC,58,59,60 5-uorouracil (5-FU),19,59,61 corticosteroids,61 and anti-VEGFs are the most popular agents. Comparison of fibrin glue versus suture for conjunctival autografting in pterygium surgery: A meta-analysis. ASCRS Cornea Clinical Committee. reported the safety and efficacy of fibrin glue in recurrent pterygium cases, which were treated with pterygium excision and CAU-MMC combination.71 After a mean follow-up of 26.5 months, only one patient developed recurrence (3.6%). 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). However, as there is no clear evidence that ranibizumab is superior to bevacizumab in this area, bevacizumab is still considered the first-line choice by many authors because of the lower cost. Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative antimetabolite use. Triple subconjunctival bevacizumab injection for early corneal recurrent pterygium: One-year follow-up. Mauro J, Foster CS. bare sclera and postoperative MMC ranges from . However, the literature is still updating with newer surgical and/or nonsurgical methods to decrease the recurrence and improve the cosmetic outcomes. Changes of tear film function after pterygium operation. The recurrence rate was 2 eyes in group 1 (10%) (limbal stem cell transplantation + conjunctival autograft), 6 eyes in group 2 (30%) (AMT) and 4 eyes (20%) in group 3 (MMC + AMT). These studies did not show any benefit of bevacizumab injection on recurrence rates.87 Studies that were evaluating the efficacy of bevacizumab injections on the day before surgery were unable to conclude beneficial effects or to find a significant decrease in the rate of recurrence.88 Briefly, multiple injections seem to have greater efficacy and longer duration of action in comparison to a single injection. Julio G, Lluch S, Pujol P, Alonso S, Merindano D. Tear osmolarity and ocular changes in pterygium. Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium. Pan HW, Zhong JX, Jing Cx. An official website of the United States government. Trkylmaz K, Oner V, Sevim M, Kurt A, Sekeryapan B, Durmu M. Effect of pterygium surgery on tear osmolarity. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Fifty patients were randomized into either sutured graft or glued graft groups. Chen Q, Li Y, Xu F, Yan Y, Lu K, Cui L, et al. MMC was applied for 1-3 min. In their case series, they treated four patients who presented with recurrent pterygium and applied MMC 0.02% for 23 min subconjunctivally after excision. found abnormal tear film function and osmolarity in primary pterygium cases, which improved after pterygium excision.16 However, tear osmolarity deteriorated again when recurrence happened. This technique included extensive tenonectomy and pterygium resection followed by the transplantation of a large CAU, which led to very low recurrence rates (0.1% for 1000 patients) in primary and recurrent cases.50 In 2015, Katircioglu et al.