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Combined Technique for Extensive and Multiple Recurrent Pterygium

Combined Technique for Extensive and Multiple Recurrent Pterygium. Diane Marinho, Andressa P. Stolz, Sergio Kwitko, Andreia Laranjeira , Samuel Rymer Ophthalmology Department - Hospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - Brazil

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Combined Technique for Extensive and Multiple Recurrent Pterygium

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  1. Combined Technique for Extensiveand Multiple Recurrent Pterygium Diane Marinho, Andressa P. Stolz, Sergio Kwitko, Andreia Laranjeira, Samuel Rymer Ophthalmology Department - Hospital de Clínicas de Porto AlegreFederal University of Rio Grande do Sul - Porto Alegre - Brazil The authors have no financial interest in the subject matter of this poster

  2. Purpose • One of the major goals of pterygium surgery is the prevention of recurrence. • Recurrent pterygium tends to be difficult to treat because it is accompanied in many cases by increased conjunctival inflammation and accelerated corneal involvement, symplepharon formation and consequent diplopia. To describe the clinical outcome of a combined surgery procedure, proposed by Miyaiet al1, for extensive or multiple recurrent pterygium.

  3. Methods • Interventional case series of 9 eyes of 7 patients with multiple recurrent pterygium, symblepharon and diplopia, in which autograftdisponibility was limited. Procedure: Extensive Tenon and conjunctival excision Amniotic membrane for fornix and tarsal reconstruction Intraoperative 0.02% mitomycin-C for 5 minutes Cadaver limbal allograft

  4. Results • Mean number of previous procedures per eye was 4.7 • Cadaver limbal allografts were fully integrated in 8 eyes • Diplopia was solved in all cases • Pterygium recurred in a sole eye during follow-up time (mean 11.8 months; range, 3-24 months) • No complications related to mitomycin usage were noted • Visual acuity improved or maintained stable in all but one patient, and this case was attributed to irregular astigmatism

  5. Table 1: Cases included in study

  6. Figure 01. Eye 1: Pre and postoperative (24 months). Figure 02. Eye 2: pre and postoperative (19 months).

  7. Figure 03. Eye 3: postoperative 1 week and 5 months. Figure 04. Eye 4: pre and postoperative (7 months).

  8. Figure 05. Eye 5: pre and postoperative (12 months). Figure 06. Eye 6: pre and postoperative (1 month).

  9. Figure 07. Eye 7: pre and postoperative (4 months). Figure 08. Eye 8: pre and postoperative (3 months).

  10. Figure 09. Eye 9: pre and postoperative (3 months).

  11. Conclusion • Our mid-term results show that this combined surgical technique appears to be effective and safe in the treatment of extensive and/or multiple recurrent pterygium. Moreover, this procedure seems to offer better results than does the isolated use of each technique.

  12. References • Miyai T, Hara R, Nejima R, Miyata K, Yonemura T, Amano S. Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium. Ophthalmology 2005;112:1263-7. • Solomon A, Espana EM, Tseng SC. Amniotic membrane transplantation for reconstruction of the conjunctival fornices. Ophthalmology 2003;110:93-100. • Avisar R, Gaton DD, Loya N, Appel I, Weinberger D. Intraoperative mitomycin C 0.02% for pterygium: effect of duration of application on recurrence rate. Cornea 2003;22:102-4. • Shimazaki J, Shinozaki N, Tsubota K. Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon. Br J Ophthalmol 1998;82:235-40. • Gris O, Guell JL, del Campo Z. Limbal-conjunctival autograft transplantation for the treatment of recurrent pterygium. Ophthalmology 2000;107:270-3.

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