Management of pterygium: our experience and a simplified treatment algorithm

Area of Science:

• Ophthalmology
• Surgical Techniques
• Ocular Surface Disease

Background:

• Pterygium, a common ocular surface condition, requires effective surgical management to minimize recurrence and ensure good cosmetic outcomes.
• Various surgical techniques exist for pterygium excision, each with potential benefits and drawbacks regarding recurrence rates and patient recovery.

Purpose of the Study:

• To explore diverse surgical approaches for pterygium management.
• To propose a simplified, evidence-based treatment algorithm for surgical pterygium cases.
• To evaluate the recurrence rates and cosmetic outcomes of different surgical techniques in a large patient cohort.

Main Methods:

• Retrospective analysis of 9219 eyes undergoing pterygium surgery.
• Categorization of patients into four groups based on pterygium type (primary/recurrent, single/double-head).
• Evaluation of various surgical techniques including conjunctival autograft (CAG), conjunctival tissue graft from pterygium (CTG-P), amniotic membrane graft (AMG), extended resection (ER), and mitomycin-C (MMC).

Main Results:

• Low pterygium recurrence rates were observed across all four groups, ranging from 0.47% to 7.69%.
• Conjunctival autograft (CAG) with various modifications (split, inferior+superior) demonstrated efficacy in primary and recurrent pterygium.
• Adjunctive therapies like mitomycin-C (MMC) and techniques like CTG-P and AMG also showed promising low recurrence rates.

Conclusions:

• All evaluated surgical methods for pterygium management are viable options with low recurrence rates.
• The study's findings support the development of a simplified treatment algorithm for pterygium.
• Large sample size and long follow-up strengthen the evidence for these surgical approaches.