Learning curve in the Cut and Paste method for surgery of primary pterygium

To evaluate the learning curve for the surgery of primary nasal pterygium with conjunctival autograft using fibrin adhesive (the Cut and Paste method).

The outcomes of the first consecutive 120 primary pterygium surgery cases for two surgeons (groups A and B) were investigated retrospectively and compared with the first (group C) and second (group D) 120 cases of GK. A and B were previously inexperienced in pterygium surgery. Outcome variables were surgery time, complications, the number and the temporal distribution of the recurrences. The statistics used were moving averages of the recurrences, Scheffé's test of means, learning curve analysis according to Wright and logarithmic curve fitting to operation time data. The impact of age and sex on recurrences was tested using t-tests and chi-square tests.

The mean surgery time was 17 min for A, 13 min for B and 13 min for GK. There was a certain learning curve slope in operation time in groups A and C. The postoperative complications were few and acceptable. There were ten (8.9%) recurrences in group A, eight (6.8%) in group B, six (5.5%) in group C and five (4.6%) in group D. The temporal distribution of the recurrences did not show any learning curve. Age and sex had no significant correlation with recurrence rate or surgery time (data not shown).

Our study indicates that the Cut and Paste technique is easy to learn and master. We did not find a significant learning curve regarding surgery time, recurrences or complications. In a clinical setting, it is beneficial to let a few, otherwise experienced eye surgeons learn the technique.