Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Long-term Outcomes of Conjunctivo-limbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

군날개 재발에 있어서 자가윤부결막이식술 단독 및 추가 윤부절개술의 장기 결과

  • Chung, In Kwon (Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jin Hyoung (Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Jong Hyun (Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Do Hyung (Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine)
  • 정인권 (인제대학교 의과대학 일산백병원 안과학교실) ;
  • 김진형 (인제대학교 의과대학 일산백병원 안과학교실) ;
  • 이종현 (인제대학교 의과대학 일산백병원 안과학교실) ;
  • 이도형 (인제대학교 의과대학 일산백병원 안과학교실)
  • Received : 2018.09.06
  • Accepted : 2018.11.30
  • Published : 2018.12.15
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Abstract

Purpose: We report the clinical outcomes of patients undergoing additional widening of the limbal incision to prevent disease recurrence after conjunctivo-limbal autograft combined with pterygial excision. Methods: We retrospectively compared 95 eyes with primary and 12 eyes with recurrent pterygia randomized to treatment via two surgical methods: conjunctivo-limbal autograft alone and combined with widening of the limbal incision to allow for pterygial removal. We widened the limbal incisions by 1 mm on both the superior and inferior limbal margins and removed the pterygia. The outcomes were compared between 39 eyes undergoing conjunctivo-limbal autograft alone and 68 eyes undergoing conjunctivo-limbal autograft with widening of the limbal incision. Results: The mean overall postoperative follow-up period was $29.6{\pm}10.5months$ and conjunctivo-limbal autograft alone group was $27.4{\pm}11.5months$, combined with widening of the limbal incision group was $30.7{\pm}9.7months$. Six pterygia (15.4%; four primary and two recurrent) developed in those undergoing conjunctivo-limbal autograft alone and two (2.9%; one primary and one recurrent) in those undergoing additional widening of the limbal incision; the recurrence rate differed significantly between the two groups (p < 0.05). In the group treated with conjunctivo-limbal autograft alone, the mean time to development of a new primary pterygium was $6.3{\pm}3.4months$ and that to development of a recurrent pterygium $4.3{\pm}2.5months$; the respective values for the group undergoing additional widening of the limbal incision were $12.1{\pm}2.6$ and $8.4{\pm}4.6months$; the recurrence rates differed significantly (p < 0.05). Conclusions: Conjunctivo-limbal autograft with additional widening of the limbal incision used to treat both new primary and recurrent pterygia was more effective in terms of reducing pterygial recurrence than conjunctivo-limbal aAutograft alone.

목적: 군날개 수술에서 자가윤부결막이식술 시 재발을 억제하기 위하여 시행한 추가 윤부절개술의 임상성적을 보고하고자 한다. 대상과 방법: 총 95안의 원발성군날개와 12안의 재발성 군날개 환자를 대상으로 자가윤부결막이식술 단독 및 추가 윤부절개술을 시행한 두 군으로 나누어 후향적 분석을 시행하였다. 추가 윤부절개술은 군날개를 제거한 각막윤부의 상부 및 하부경계에 각각 1 mm의 추가 절개를 하는 방법으로 시행하였다. 결과는 자가윤부결막이식술 단독 시행 39안, 추가 윤부절개술 시행 68안을 대상으로 비교 분석하였다. 결과: 전체 환자의 술 후 경과관찰 기간은 $29.6{\pm}10.5$개월이었으며, 자가윤부결막이식술 단독 시행 군에서는 $27.4{\pm}11.5$개월, 추가 윤부절개술 군에서는 $30.7{\pm}9.7$개월이었다. 재발은 자가윤부결막이식술 단독 시행 군에서는 6안(15.4%; 원발성 4안, 재발성 2안)이 있었으며, 추가 윤부절개술 군에서는 2안(2.9%; 원발성 1안, 재발성 1안)을 나타내었고, 두 군 간에 통계적으로 유의한 차이를 보였다(p<0.05). 재발이 나타날 때까지의 평균 기간은 자가윤부결막이식술 단독 시행 군에서 원발성 군날개인 경우 $6.3{\pm}3.4$개월, 재발성군날개인 경우 $4.3{\pm}2.5$개월이었으며, 추가 윤부절개술 군에서는 원발성 $12.1{\pm}2.6$개월, 재발성 $8.4{\pm}4.6$개월을 나타내었고, 두 군 간 통계적으로 유의한 차이를 보였다(p<0.05). 결론: 추가 윤부절개술은 자가윤부결막이식술을 단독 시행하였을 때보다 원발성 및 재발성 군날개 모두에서 재발 방지에 유용한 수술법이다.

Keywords

References

  1. Taylor HR, West S, Munoz B, et al. The long-term effects of visible light on the eye. Arch Ophthalmol 1992;110:99-104. https://doi.org/10.1001/archopht.1992.01080130101035
  2. Di Girolamo N, Chui J, Coroneo MT, Wakefield D. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res 2004;23:195-228. https://doi.org/10.1016/j.preteyeres.2004.02.002
  3. Chui J, Coroneo MT, Tat LT, et al. Ophthalmic pterygium: a stem cell disorder with premalignant features. Am J Pathol 2011;178:817-27. https://doi.org/10.1016/j.ajpath.2010.10.037
  4. Kim YJ, Yoo SH, Chung JK. Reconstruction of the limbal vasculature after limbal-conjunctival autograft transplantation in pterygium surgery: an angiography study. Invest Ophthalmol Vis Sci 2014;55:7925-33. https://doi.org/10.1167/iovs.14-15288
  5. Rim H, Kang MJ, Choi M, et al. The incidence and prevalence of pterygium in South Korea: a 10-year population-based Korean cohort study. PLoS One 2017;12:e0171954. https://doi.org/10.1371/journal.pone.0171954
  6. Kim DI, Kim MK, Wee WR, Oh JY. Surgical outcome of primary pterygium excision with conjunctival autograft. J Korean Ophthalmol Soc 2015;56:856-62. https://doi.org/10.3341/jkos.2015.56.6.856
  7. Ang LP, Chua JL, Tan DT. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol 2007;18:308-13. https://doi.org/10.1097/ICU.0b013e3281a7ecbb
  8. Hong SM, Ko SJ, Kim SD. Effect of inferior conjunctival transposition flap surgery for primary pterygium. J Korean Ophthalmol Soc 2009;50:1774-9. https://doi.org/10.3341/jkos.2009.50.12.1774
  9. Gris O, Guell JL, del Campo Z. Limbal-conjunctival autograft transplantation for the treatment of recurrent pterygium. Ophthalmology 2000;107:270-3. https://doi.org/10.1016/S0161-6420(99)00041-X
  10. Zheng K, Cai J, Jhanji V, Chen H. Comparison of pterygium recurrence rates after limbal conjunctival autograft transplantation and other techniques: meta-analysis. Cornea 2012;31:1422-7. https://doi.org/10.1097/ICO.0b013e31823cbecb
  11. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997;115:1235-40. https://doi.org/10.1001/archopht.1997.01100160405001
  12. Allan BD, Short P, Crawford GJ, et al. Pterygium excision with conjunctival autografting: an effective and safe technique. Br J Ophthalmol 1993;77:698-701. https://doi.org/10.1136/bjo.77.11.698
  13. Kwon SH, Kim HK. Analysis of recurrence patterns following pterygium surgery with conjunctival autografts. Medicine (Baltimore) 2015;94:e518. https://doi.org/10.1097/MD.0000000000000518
  14. KEEDS. Cornea, 3rd ed. Seoul: Ilchokak Publishing Co., Ltd., 2013; 771-5.
  15. Tseng SC. Concept and application of limbal stem cells. Eye (Lond) 1989;3(Pt 2):141-57. https://doi.org/10.1038/eye.1989.22
  16. Anquria P, Carmichael T, Ntuli S, Kitinya J. Chronic inflammatory cells and damaged limbal cells in pterygium. Afr Health Sci 2013;13:725-30.
  17. Sebban A, Hirst LW. Pterygium recurrence rate at the Princess Alexandra Hospital. Aust N Z J Ophthalmol 1991;19:203-6. https://doi.org/10.1111/j.1442-9071.1991.tb00661.x
  18. Han HC, Kim JH, Lee DH. The changes of corneal higher-order aberrations after surgery according to pterygium size. J Korean Ophthalmol Soc 2014;55:32-9. https://doi.org/10.3341/jkos.2014.55.1.32
  19. Hirst LW, Axelsen RA, Schwab I. Pterygium and associated ocular surface squamous neoplasia. Arch ophthalmol 2009;127:31-2. https://doi.org/10.1001/archophthalmol.2008.531
  20. Hacioglu D1, Erdol H. Developments and current approaches in the treatment of pterygium. Int Ophthalmol 2017;37:1073-81. https://doi.org/10.1007/s10792-016-0358-5
  21. Young AL, Ho M, Jhanji V, Cheng LL. Ten-year results of a randomized controlled trial comparing 0.02% mitomycin C and limbal conjunctival autograft in pterygium surgery. Ophthalmology 2013;120:2390-5. https://doi.org/10.1016/j.ophtha.2013.05.033
  22. Murube J. Pterygium: its treatment with beta therapy. Ocul Surf 2009;7:3-9. https://doi.org/10.1016/S1542-0124(12)70287-2
  23. Khan MS, Malik S, Basit I. Effect of intralesional 5 fluorouracil injection in primary pterygium. Pak J med Sci 2016;32:130-3.
  24. Rua O, Larrayoz IM, Barajas MT, et al. Oral doxycycline reduces pterygium lesions; results from a double blind, randomized, placebo controlled clinical trial. PLoS One 2012;7:e52696. https://doi.org/10.1371/journal.pone.0052696
  25. Chen KH, Hsu WM. Intraoperative ethanol treatment as an adjuvant therapy of pterygium excision. Int J Biomed Sci 2006;2:414-21.
  26. Kim YI, Lee GY, Kim EJ, et al. The Effect of subconjunctival bevacizumab Injection before conjunctival autograft for pterygium. J Korean Ophthalmol Soc 2015;56:847-55. https://doi.org/10.3341/jkos.2015.56.6.847
  27. Besharati, Manaviat, Souzani A. Subconjunctival bevacizumab injection in treatment of pterygium. Acta Med Iran 2011;49:179-83.
  28. Kim CH, Lee JK, Park DJ. Recurrence rates of amniotic membrane transplantation, conjunctival autograft and conjunctivolimbal autograft in primary pterygium. J Korean Ophthalmol Soc 2009;50:1780-8. https://doi.org/10.3341/jkos.2009.50.12.1780
  29. Gazzard G, Saw SM, Farook M, et al. Pterygium in Indonesia: prevalence, severity and risk factors. Br J Ophthalmol 2002;86:1341-6. https://doi.org/10.1136/bjo.86.12.1341
  30. Kim KW, Kim JC. The clinical effect of micro-multiporous expanded polyeterafluoroethylene insertion for recurrent pterygium. J Korean Ophthalmol Soc 2013;54:416-26. https://doi.org/10.3341/jkos.2013.54.3.416
  31. Kenyon KR, Tseng SC. Limbal autograft transplantation for ocular surface disorders. Ophthalmology 1989;96:709-22. https://doi.org/10.1016/S0161-6420(89)32833-8
  32. Hirst LW. Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation. Ophthalmology 2008;115:1663-72. https://doi.org/10.1016/j.ophtha.2008.03.012
  33. Hirst LW. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. Ophthalmology 2012;119:2205-10. https://doi.org/10.1016/j.ophtha.2012.06.021
  34. Lee JS, Ha SW, Yu S, et al. Efficacy and safety of a large conjunctival autograft for recurrent pterygium. J Korean Ophthalmol Soc 2017;31:469-78. https://doi.org/10.3341/kjo.2016.0135
  35. Barraquer JI. Etiology, pathogenesis, and treatment of the pterygium. Trans New Orleans Acad Ophthalmol 1980;28:167-78.
  36. Kria L, Ohira A, Amemiya T. Growth factors in cultured pterygium fibroblasts: immunohistochemical and ELISA analysis. Graefes Arch Clin Exp Ophthalmol 1998;236:702-8. https://doi.org/10.1007/s004170050144
  37. Kria L, Ohira A, Amemiya T. TNP-470 (a fungus-derived inhibitor of angiogenesis) reduces proliferation of cultured fibroblasts isolated from primary pterygia: a possible drug therapy for pterygia. Curr Eye Res 1998;17:986-93. https://doi.org/10.1076/ceyr.17.10.986.5245
  38. John T. Pterygium excision and conjunctival mini-autograft: preliminary report. Eye (Lond) 2001;15(Pt 3):292-6. https://doi.org/10.1038/eye.2001.97
  39. Hwang HS, Cho KJ, Rand G, et al. Optimal size of pterygium excision for limbal conjunctival autograft using fibrin glue in primary pterygia. BMC Ophthalmol 2018;18:135. https://doi.org/10.1186/s12886-018-0790-6
  40. Bazzazi N, Ramezani A, Rabiee MA. A comparative study of conjunctival autograft and minimally invasive pterygium surgery in primary pterygia. Pak J Biol Sci 2010;13:409-12. https://doi.org/10.3923/pjbs.2010.409.412
  41. Masters JS, Harris DJ. Low recurrence rate of pterygium after excision with conjunctival Limbal autograft: a retrospective study with long-term follow-up. Cornea 2015;34:1569-72. https://doi.org/10.1097/ICO.0000000000000597