Surgical treatment of pterygium

Petraevskiĭ A.V.; Trishkin K.S.

doi:https://doi.org/10.17116/oftalma2018134185-88

Close metadata

Recommended articles:

Efficacy of chemoimmunotargeted therapy in patients with advanced non-small cell lung cancer in real clinical practice. P.A. Herzen Journal of Oncology. 2025;(3):63-70

Abstract:

Pterygium is one of the modern problems of ophthalmology. The exact etiology and pathogenesis of this disease has not been reliably established and, as a result, there is no universal method for its recurrence-free treatment. The literature data on various methods of pterygium surgical treatment such as «bare sclera», conjunctival autograft, limbal stem cells transplantation techniques, amniotic membrane plasty and other methods was analyzed. The advantages and disadvantages of those surgery methods were identified. With consideration of the new data on proliferative nature of the disease, the results of adjuvant treatment of pterygium using cytostatics and anti-VEGF drugs were examined. Introduction of new technologies for the treatment of pterygium in practical health care can significantly improve the effectiveness of surgeries, reduce the incidence of postoperative complications and the number of relapses of the disease.

Keywords:

pterygium

conjunctival autograft

amniotic membrane

limbal stem cells

fibrin glue

Mitomycin-C

Cyclosporin A

Bevacizumab

anti-VEGF preparations

Authors:

Petraevskiĭ A.V.

GBOU VPO "Volgogradskiĭ gosudarstvennyĭ meditsinskiĭ universitet" Minzdravsotsrazvitiia Rossii

Trishkin K.S.

GBOU VPO "Volgogradskiĭ gosudarstvennyĭ meditsinskiĭ universitet" Minzdrava Rossii

Close metadata

References:

Zhou W, Zhu Y, Zhang B, Qiu W, Yao Y. The role of ultraviolet radiation in the pathogenesis of pterygia (Review). Molecular Medicine Reports. 2016. https://doi.org/10.3892/mmr.2016.5223
Young C-H, Lo Y-L, Tsai Y-Y, Shih T-S, Lee H, Cheng Y-W. CYP1A1 gene polymorphisms as a risk factor for pterygium. Molecular Vision. 2010; 16:1054-1058.
Romano V, Steger B, Kovacova A, Kaye S, Willoughby C. Further evidence for heredity of pterygium. Ophthalmic Genetics. 2016;37(4):434-436. https://doi.org/10.3109/13816810.2015.1111911
Piecyk-Sidor, M. Polz-Dacewicz, Z. Zagórski, T. Zarnowski. Occurrence of human papillomavirus in pterygia. Acta Ophthalmologica. 2009;87(8):890-895. https://doi.org/10.1111/j.1755-3768.2008.01372.x
Ishioka M, Shimmura S, Yagi Y, Tsubota K. Ptyerygium and Dry Eye. Ophthalmologica. 2001;215(3):209-211. https://doi.org/10.1159/000050860
Petrayevsky AV, Trishkin KS. Pathogenetic link between pterygium and dry eye syndrome (clinical and cytological research). Vestnik oftal’mologii.2014;1:52-56. (In Russ.)
Golu T, Mogoantă L, Streba CT, Pirici DN, Mălăescu D, Mateescu GO, Muţiu G. Pterygium: histological and immunohistochemical aspects. Rom J Morphol Embryol. 2011;52(1):153-158.
Livezeanu C, Crăiţoiu MM, Mănescu R, Mocanu C, Crăiţoiu S. Angiogenesis in the pathogenesis of pterygium Rom J Morphol Embryol. 2011; 52(3):837-844.
Petrayevsky AV, Trishkin KS. Changes in the microcirculation of the bulbar conjunctiva in the primary pterygium. Oftal’mologiya. 2013;10(3):58-62. (In Russ.)
Liang K, Jiang Z, Ding B, Cheng P, Huang D, Tao L. Expression of cell proliferation and apoptosis biomarkers in pterygia and normal conjunctiva. Molecular Vision. 2011;17:1687-1693.
Sang AM, Lu H. Expression of p53 and flow cytometric analysis of DNA index and S-phase fraction in pterygium. Zhonghua Yi Xue Za Zhi. 2010;90(27):1890-1892.
Ljubojevic V, Gajanin R, Amidzic L, Vujkovic Z. The expression and significance of p53 protein and Ki-67 protein in pterygium. Vojnosanitetski pregled. 2016;73(1):16-20. https://doi.org/10.2298/vsp140428124l
Ozturk B, Yıldırım M, Zamani A, Bozkurt B. K-ras oncogene mutation in pterygium. Eye. 2016;31(3):491-498. https://doi.org/10.1038/eye.2016.254
Holland E. Ocular Surface Disease. 1st ed. Dordrecht: Springer; 2004.
Alpay A, Uğurbaş SH, Erdoğan B. Comparing techniques for pterygium surgery. Clinical ophthalmology (Auckland, NZ). 2009;3:69-74.
Gonzales Gomez A, Gonzales de Gor Crooke J, Garcia-Ben A, Garcia-Campos J. Dellen and corneal perforation after bilateral pterygium excision in a patient with no risk factors. BMJ Case Reports.2015:bcr2015213319. https://doi.org/10.1136/bcr-2015-213319
Hirst L. The Treatment Of Pterygium. Survey of Ophthalmology. 2003; 48(2):145-180. https://doi.org/10.1016/s0039-6257(02)00463-0
Belyi YA, Tereshchenko AV, Vatolin MN. A. Photodynamic therapy at the stage of surgical removal of the pterygium. Oftal’mologiya. 2008;5(1):41-45. (In Russ.)
Petrayevsky AV, Trishkin KS. Method of surgical treatment of pterygium. Oftal’mokhirurgiya. 2012;4:28-32. (In Russ.)
Prabhasawat P, Barton K, Burkett G, Tseng S. Comparsion of Conjunctival Autografts, Amniotic Membrane Grafts, and Primary Closure for Pterygium Excision. Ophthalmology. 1997;104(6):974-985. https://doi.org/10.1016/s0161-6420(97)30197-3
Sadiq MN, Arif AS, Jaffar S, Bhatia J. Use of supero-temporal free conjunctivo-limbal autograft in the surgical management of pterygium: our technique and results. J Ayub Med Coll Abbottabad. 2009;21(4):121-124.
Fuest M, Liu Y, Yam G et al. Femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery. The Ocular Surface. 2016. https://doi.org/10.1016/j.jtos.2016.12.001
Romano V, Cruciani M, Conti L, Fontana L. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. Cochrane Database of Systematic Reviews. 2014.
Shi YJ, Yan ZG, Yue HY, Yang L, Lin B. Meta-analysis of fibrin glue for attaching conjunctival autografts in pterygium surgery. Zhonghua Yan Ke Za Zhi. 2011;47(6):550-554.
Cagatay H, Gökçe G, Alper M, Koban Y, Ekinci M. Non-Recurrence Complications of Fibrin Glue Use in Pterygium Surgery: Prevention and Management. The Open Ophthalmology Journal. 2015;9(1):159-163. https://doi.org/10.2174/1874364101509010159
Allam W. Recurrence and complications of pterygium extended removal followed by extended conjunctival transplant for primary pterygia. European Journal of Ophthalmology. 2015;26(3):203-208. https://doi.org/10.5301/ejo.5000685
Cornelius C. Recurrence Rate and Complications of Pterygium Extended Removal Followed by Extended Conjunctival Transplant. Cornea. 2017;36(1):101-103. https://doi.org/10.1097/ico.0000000000001026
Bozkir N, Yilmaz S, Maden A. Minimally invasive pterygium surgery: a new approach for prevention of recurrence. Eur J Ophthalmol. 2008;18(1):27-31.
Sakarya Y, Sakarya R, Kara S. Reversal of sensation of conjunctival autograft after pterygium surgery. European Journal of Ophthalmology. 2011; 22(Suppl.7):11-16. https://doi.org/10.5301/ejo.5000082
Yamazoe K, Shimazaki-Den S, Otaka I, Hotta Shimazaki. Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft. Clinical Ophthalmology. 2011:1609. https://doi.org/10.2147/opth.s24885
Zolotarev AV, Milyudin ES. Surgical treatment of a recurring pterygium with plasty of silicium-dried amniotic membrane. Vestnik oftal’mologii. 2007;1:39-42. (In Russ.)
Shusko A, Hovanesian J. Pterygium excision with conjunctival autograft and subconjunctival amniotic membrane as antirecurrence agents. Canadian Journal of Ophthalmology. 2016;51(6):412-416. https://doi.org/10.1016/j.jcjo.2016.02.022
Bondalapati S, Ambati B. Minimally Invasive Pterygium Surgery: Sutureless Excision with Amniotic Membrane and Hydrogel Sealant. Case Reports in Ophthalmology. 2016;7(1):79-84. https://doi.org/10.1159/000444076
Kheirkhah A, Nazari R, Nikdel M, Ghassemi H, Hashemi H, Behrouz M. Postoperative Conjunctival Inflammation After Pterygium Surgery With Amniotic Membrane Transplantation Versus Conjunctival Autograft. American Journal of Ophthalmology. 2011;152(5):733-738. https://doi.org/10.1016/j.ajo.2011.04.013
Ozkurt Y, Kocams O, Comez A, Uslu B, Dogan O. Treatment of Primary Pterygium. Optometry and Vision Science. 2009;86(10):1178-1181. https://doi.org/10.1097/opx.0b013e3181baac1a
Mahdy M, Bhatia J. Treatment of primary pterygium: Role of limbal stem cells and conjunctival autograft transplantation. Oman Journal of Ophthalmology. 2009;2(1):23. https://doi.org/10.4103/0974-620x.48418
Ali A, Thariat J, Bensadoun R et al. The role of radiotherapy in the treatment of pterygium: A review of the literature including more than 6000 treated lesions. Cancer/Radiothérapie. 2011;15(2):140-147. https://doi.org/10.1016/j.canrad.2010.03.020
Chang Y, Chen W, Tseng S, Sze C, Wu C. Subconjunctival Mitomycin C Before Pterygium Excision. Cornea. 2008;27(4):471-475. https://doi.org/10.1097/ico.0b013e318164221c
Díaz L, Villegas V, Emanuelli A, Izquierdo N. Efficacy and Safety of Intraoperative Mitomycin C as Adjunct Therapy for Pterygium Surgery. Cornea. 2008;27(10):1119-1121.
Alizadeh R, Shokouhi-Rad S, Daneshvar R. Iatrogenic bleb formation and hypotony maculopathy following pterygium surgery with Mitomycin-C. Journal of Ophthalmic and Vision Research. 2015;10(3):345. https://doi.org/10.4103/2008-322x.170341
Özülken K, Koç M, Ayar O, Hasiripi H. Topical cyclosporine A administration after pterygium surgery. European Journal of Ophthalmology. 2011;22(Suppl.7):5-10. https://doi.org/10.5301/ejo.5000004
Gum S, Kim Y, Jung J et al. Cyclosporine A inhibits TGF-β2-induced myofibroblasts of primary cultured human pterygium fibroblasts. Biochemical and Biophysical Research Communications. 2017;482(4):1148-1153. https://doi.org/10.1016/j.bbrc.2016.12.002
Poryadin VR, Dostovalov SN, Senchenko NYa, Yur’eva TN. Measures for preventing recurrence of the primary progressive pterygium. Prakticheskaya meditsina. 2012;59(4):115-117. (In Russ.)
Singh P, Sarkar L, Sethi H, Gupta V. A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients. Indian Journal of Ophthalmology. 2015;63(10):779. https://doi.org/10.4103/0301-4738.171508
Kasetsuwan N, Reinprayoon U, Satitpitakul V. Prevention of Recurrent Pterygium with Topical Bevacizumab 0.05% Eye Drops: A Randomized Controlled Trial. Clinical Therapeutics. 2015;37(10):2347-2351. https://doi.org/10.1016/j.clinthera.2015.08.023