Evaluation of outcome of primary pterygium excision combined with different techniques

Abstract

To compare different techniques combined with excision in treatment of primary pterygium: Amniotic membrane transplant [AMG], Limbal-conjunctival autograft [CLAG], and mitomycin c with limbal-conjunctival autograft.[MMC+CLAG]: A prospective comparative study was performed in tertiary hospital on 105 patients satisfying the inclusion and exclusion criteria. Combined with excision, 35 eyes each were treated with AMG transplantation [Group 1] and CLAG [Group 2] for closure of defect. In 35 eyes low-dose mitomycin -C [0.02%] was applied on bare sclera for 1 minute and a CLAG was applied thereafter [Group 3]. Patients were followed up for 9 months.Study was conducted from June 2018 to April 2020 on patients of age 26 to 72 years with mean age of 46.3 ± 10 years with 42[40%] male and 63[60%] female. A statistically significant change [ paired t test, p<0.001] was noted in K-horizontal value pre- and post- pterygium surgery. Change in K-vertical pre- and post- surgery was not statistically significant [paired t test, p<0.58]. Pterygium recurred in 3 patients [8.6%] in group 1, 1 patient [2.9%] each in group 2 and 3. Other postoperative complications include graft displacement [5.7%], graft oedema [6.7%] and congestion [9.5%]. A minor case of scleral melting was noted in one patient [2.9%] in group 3. Pterygium excision followed by CLAG and MMC+CLAG are an effective way of reducing recurrence. However close monitoring is required for use of adjuvant MMC.AMG can be reserved in patients with bilateral pterygium, severe limbal stem cell loss and in need of glaucoma surgery.