Original article
Postoperative Conjunctival Inflammation After Pterygium Surgery With Amniotic Membrane Transplantation Versus Conjunctival Autograft

https://doi.org/10.1016/j.ajo.2011.04.013Get rights and content

Purpose

To compare the postoperative conjunctival inflammation around the surgical site after pterygium surgery using either amniotic membrane transplantation (AMT) or free conjunctival autograft.

Design

Prospective, randomized, interventional study.

Methods

Forty-two eyes of 42 patients with primary pterygium underwent surgical excision followed by removal of subconjunctival fibrovascular tissue and intraoperative application of 0.02% mitomycin C. Then, the patients were randomized to receive either AMT (21 eyes) or free conjunctival autograft (21 eyes), with sutures used in both groups. Main outcome measures included presence of host conjunctival inflammation around the surgical site at 1 month after surgery and also recurrence of pterygium.

Results

Twelve-month follow-up was completed in 39 eyes of 39 patients (19 in the AMT group and 20 in the conjunctival autograft group). At 1 month after surgery, different grades of host conjunctival inflammation were present in 16 eyes (84.2%) in the AMT group and in 3 eyes (15%) in the conjunctival autograft group (P = .02). Subconjunctival injection of triamcinolone was performed in eyes with moderate or severe inflammation, which included 12 eyes (63.1%) in the AMT group and 2 eyes (10%) in the conjunctival autograft group (P < .001). Conjunctival recurrence of pterygium was seen in 2 eyes (10.5%) in the AMT group and in 2 eyes (10%) in the conjunctival autograft group (P = .92). After surgery, pyogenic granuloma developed in 3 eyes (15.8%) in the AMT group and in 1 eye (5%) in the conjunctival autograft group (P = .31).

Conclusions

After pterygium surgery, conjunctival inflammation was significantly more common with AMT than with conjunctival autograft. However, with control of such inflammation and intraoperative application of mitomycin C, similar final outcomes were achieved with both techniques.

Section snippets

Methods

In this prospective randomized study, 42 eyes of 42 patients with primary nasal pterygium underwent surgical excision. The patients were randomized to receive either amniotic membrane transplantation (21 eyes; AMT group) or free conjunctival autograft (21 eyes; conjunctival autograft group). Furthermore, there was an additional randomization of pterygia in each group based on the morphologic features of pterygium, as described below.

Before surgery and at all visits after surgery, each patient

Results

Of 42 eyes included in this study, 12-month follow-up was completed in 39 eyes of 39 patients (22 men and 17 women) with a mean age of 45.6 ± 13.9 years (range, 19 to 83 years). These included 19 eyes in AMT group and 20 eyes in conjunctival autograft group. There were no statistically significant differences in age, gender, and grade of pterygium morphologic features before the surgery between the 2 groups (Table). Surgery was uneventful in all cases; secured attachment of both amniotic

Discussion

This prospective, randomized study showed that after pterygium surgery, conjunctival inflammation was significantly more common with AMT than with conjunctival autograft. However, with control of this inflammation and intraoperative application of MMC, similar final outcomes were achieved with both techniques. Future studies are required to evaluate the role of postoperative conjunctival inflammation in surgical outcome with other techniques of pterygium surgery.

At 1 month after pterygium

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