Results of Sutureless Autograft Transplantation in Primary Pterygium Surgery

1
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.

2
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.

3
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.

4
Methods
Follow up Cases
lt 1 Month 14
1 - lt 3 Months 41
3 - lt 6 Months 18
6 - lt 9 Months 13
9 - lt 12 Months 2
gt 12 Months 12
Double Pterygium
5
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
6
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 lt 0.05).
• The average time to recurrence was 4.6 months
  (range, 2.2-11).

7
First Day of follow up after Conjunctival
Autograft
Two months after conjunctival autograft
8
Results
Country Cases
Spain 27 27
Latin America 72 72
Mali 1 1
Total 100 100
Good Cosmetic Appearance after Conjunctival
autograft
9
Results
Nationality 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
10
Results
Eye- 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
11
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.

12
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
  29141-145) .
• (3) Uy HS, Reyes JMG, Flores JDG et al.
  Comparison of Fibrin glue and Sutures for
  Attaching Conjunctival Autograft after Pterygium
  Excision. Ophthalmology 2005 112667-671.

Acknowledgments
To 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.