Chung IK, Kim JH, Lee JH, Lee DH. Liu T, Liu Y, Xie L, He X, Bai J. However, the recurrence rate is not clinically lower than control group, Single or multiple subconjunctival ranibizumab (0.5 mg/0.05 mL) injections within 6 months of recurrence diagnosis: 5 patients received 1 injection; 4 patients received 3 injections (basal, 2 and 4 weeks), Multiple injections did not appear to be superior to a single injection with regards to conjunctival hyperemia, Single subconjunctival bevacizumab (2.5 mg/0.1 mL) injection (0.5 mL), Subconjunctival bevacizumab injection is useful for the management of recurrent pterygium, Starting from 1 month after pterygium surgery with CAU: Subconjunctival bevacizumab (2.5 mg/0.1 mL) injection (mean injection 20.78), Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, Three subconjunctival bevacizumab (2.5 mg/0.1 mL) injections within 3 months of recurrence diagnosis: Basal, 2 and 4 weeks, This method was able to regress corneal and conjunctival neovascularization in early corneal recurrent pterygia, After pterygium surgery with bare sclera: 12 patients received bevacizumab eyedrops (0.05%) 4 times daily for 3 months; 10 patients received placebo only, Short-term topical bevacizumab helped with lowering the trend for recurrence, Three monthly subtenon ranibizumab (0.5-2 mg) injections within 3-18 months of recurrence diagnosis: Basal, 1 and 2 months, In half of the cases, the recurrent pterygium growth was arrested. Amniotic membrane transplantation with narrow-strip conjunctival autograft vs conjunctival autograft for recurrent pterygia. Conclusions: According to the current evidence from literature, recurrence rates after pterygium excision with LCAG are lower when compared with the use of bare sclera, bulbar conjunctival autograft, or intraoperative mitomycin C. for eligibility according to our inclusion criteria. They showed that the levels of MMP-1 and MMP-3 in supernatant secreted by primary HPFs exhibit a different pattern from recurrent HPFs. Recurrent Pterygium Excessive exposure to outdoor condition such as ultraviolet radiation, drying and trauma from wind and dust has been proposed as the etiology of this conjunctival change Clinical Features Symptoms: Often asymptomatic or only cosmetic Rarely cause visual impairment Multimicroporous e-PTFE, preserved limbal allograft and AMT, the SLET technique, and LCAU combined with the widening of the limbal incision are among novel ways to reduce recurrence. New treatment options for pterygium. Up to now, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs, but some authors recommend these drugs as an alternative to surgery in selected patients. Therefore, long-term evaluation after surgery is necessary in cases treated by MMC. Comparison of fibrin glue with sutures for pterygium excision - PubMed Recurrence rate with inferior conjunctival autograft transplantation compared with superior conjunctival autograft transplantation in pterygium surgery: A meta-analysis. In the study by Nuhoglu et al., the meantime to recurrence was 4.3 2.1 months in the primary pterygium group compared to 4.1 2.2 months in the recurrent pterygium group, which was not statistically significant.28 In eyes without demodicosis, recurrence occurred within 6 months after surgery, but this period was longer in eyes with demodicosis, suggesting that demodicosis might contribute to conjunctival recurrence by a pathologic process that may last for a longer period.20, In addition, survival analysis is important in estimating the meantime to recurrence. Sarnicola V, Vannozzi L, Motolese PA. Shi CS, Wu Y, Shu N, Jiang LL, Jiang B. Immunohistochemical analysis of vascular endothelial growth factor (VEGF) and p53 expression in pterygium from Tunisian patients. Chen Q, Li Y, Xu F, Yan Y, Lu K, Cui L, et al. Recurrence rate using fibrin glue-assisted ipsilateral conjunctival autograft in pterygium surgery: 2-year follow-up. Galor A, Yoo SH, Piccoli FV, Schmitt AJ, Chang V, Perez VL. In 2014, they published the results showing that the size of pterygium did not correlate with TBUT and Schirmer test results.78 However, decreased TBUT, but normal Schirmer test results, could be found in pterygium cases. There is controversial evidence that LCAU is more effective than CAU for the treatment of recurrent pterygium. Ocular demodicosis as a risk factor of pterygium recurrence. Depending on the population studies, the prevalence of pterygium lies within the range of 1% to more than 30%. It has been shown that increasing the duration of intraoperative bare sclera exposure to MMC reduces recurrence and improves outcomes in the expense of increasing complications.15,62 Kaufman et al. Ultraviolet light and ocular diseases. Many authors recommend these drugs as an alternative to surgery in some patients. One hypothesis is that these drugs affect neovascularization instead of old and organized vessels. Most patients were satisfied with the cosmetic outcome. Hall RC, Logan AJ, Wells AP. Cosmetic Pterygium Surgery: Techniques and Long-Term Outcomes "If a pterygium comes back, it's a real problemit can be worse than the first occurrence. Adjuvant therapy, Amniotic membrane graft/transplant, Conjunctival autograft, Conjunctival disease, Pterygium, Pterygium management, Pterygium recurrence, Recurrent pterygium, Risk factor. pointed out the benefits of using fibrin glue versus sutures in terms of recurrence rate.66 However, Kucukerdonmez et al.52 did not confirm the superiority of fibrin glue. ASCRS Cornea Clinical Committee. Pterygium Surgery: Procedure, Recovery Time, and More MMC is one of the popular adjunctive medications used during pterygium surgery since the 1980s to decrease the recurrence rate. Inclusion in an NLM database does not imply endorsement of, or agreement with, They showed that surgical pterygium excision with the application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia.99 The same team later published their results of surgery on 10 eyes with recurrent pterygium and severe symblepharon using the same technique with addition of cryopreserved limbal allograft transplantation and found the final results to be promising.100 Expanded polytetrafluoroethylene (e-PTFE), known as Gore-Tex, is a fluoropolymer that can prevent adhesion of the wound area to adjacent tissues and promote epithelialization. Different topical steroid regimens have been suggested to control inflammation after pterygium surgery; however, none of them has been confirmed.59 Hirst et al. Changes of tear film function after pterygium operation. Recurrent Pterygium: A Review - PubMed Purpose:To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians.Methods:This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. As a library, NLM provides access to scientific literature. Population-based assessment of prevalence and risk factors for pterygium in the South Indian State of Andhra Pradesh: The Andhra Pradesh Eye Disease Study Pterygium in South India-APEDS. PDF PTERYGIUM; - World Health Organization It seems to have a lower risk of recurrence when patients with recurrent pterygium receive CAU surgery compared with AMT.94 Multiple studies carried out before 2009 suggest that CAU might be a better surgical choice for the treatment of recurrent pterygia than AMT. Tan et al. Tan J, Vollmer-Conna U, Tat L, Coroneo M. Dry-eye disease in recurrent pterygium. Summary of prospective studies on pterygium, covering the risk factors, different treatment options, and ways to improve the surgical outcomes and decrease the recurrence rate, *Superscript numbers are related cited reference numbers. A Retrospective Study to Compare the Recurrence Rate After Treatment of Hurmeric V, Vaddavalli P, Galor A, Perez VL, Roman JS, Yoo SH. Management of Pterygium - American Academy of Ophthalmology Mauro J, Foster CS. Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative antimetabolite use. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. Mahar P, Manzar N. Risk factors involved in pterygium recurrence after surgical excision. Aidenloo NS, Motarjemizadeh Q, Heidarpanah M. Risk factors for pterygium recurrence after limbal-conjunctival autografting: A retrospective, single-centre investigation. showed that augmenting CAU with Ologen implantation is effective in the management of recurrent pterygium with mild nonvision-threatening postoperative side effects comparable to that of MMC.63 It should be noted that a combination of different adjunct therapies is much better than single adjunct therapy in reducing the rate of recurrence.64. This method was considered a safe and effective surgical option for treating recurrent pterygium. Hirst introduced a variation to the standard CAU technique in 2009. Metrics Abstract Aim To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. They found LCAU with intraoperative 0.02% MMC is as efficacious as AMT with the same dose of MMC. Subconjunctival bevacizumab in the impending recurrent pterygia. As for primary pterygium, there are different surgical techniques for the management of recurrent pterygium. However, pterygium surgery is concerned with high rates of postoperative recurrence. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Katrcoglu YA, Altiparmak U, Engur Goktas S, Cakir B, Singar E, Ornek F. Comparison of two techniques for the treatment of recurrent pterygium: Amniotic membrane vs conjunctival autograft combined with mitomycin C. Chen R, Huang G, Liu S, Ma W, Yin X, Zhou S. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: A randomized controlled trial. Meta-analysis on the recurrence rates after bare sclera resection with Comparison of Pterygium Recurrence Rates Between Attending : Cornea After primary pterygium surgery there is a high risk of recurrence in the range of 24% to 89%, therefore adjuvant treatment after surgical excision should be considered [6]. Long-term outcomes of conjunctivo-limbal autograft alone and additional widening of limbal incision in recurrent pterygia. Concerning the time of recurrence, although most recurrences happen in the first 36 months after surgery, there is no clear cut-off period for recurrence, and it can occur even after many years.28 It is recommended that studies, which aim to evaluate the recurrence, should consider their follow-up period at least 1 year. 3% to 38%. An official website of the United States government. found that carriers of BRAFV600 mutation had an 8-fold increased risk of recurrence during the first year after pterygium surgery.31 In addition, viruses such as HSV, EBV, CMV, and HPV can be other risk factors for recurrence.31, It was known from the earliest reports that the incidence of pterygium is higher in areas closest to the geographical equator, which was considered due to the effect of UV light.2 Previous studies have not found gender among the proven nonsurgical risk factors for recurrence.28 However, younger age was found to be associated with a higher risk of recurrence, and patients under the age of 45 have a 3.5-fold increase in their risk of recurrence.17,28 Possible explanations for higher recurrence in younger subjects are rapid re-epithelialization, aggressive collagen synthesis, rapid angiogenesis, more robust and vigorous inflammatory response, and increased outdoor activity with high exposure to the dusty atmosphere and UV light.17,28,32, In addition, preoperative ocular surface inflammation is associated with higher postoperative recurrence rates.28 Therefore, ocular surface inflammation has a significant role in pterygium recurrence, and early clinical recognition of factors leading to pre or postoperative inflammation with the application of appropriate treatment is recommended.33,34 Ocular demodicosis is another strong perpetuating factor for increased ocular surface inflammation in association with chronic blepharitis, blepharoconjunctivitis, rosacea blepharitis, meibomian gland dysfunction, and keratitis.20,35,36,37 In a retrospective study done by Huang et al., ocular demodicosis is introduced as an overlooked risk factor for pterygium recurrence.20 Although previous studies have not shown gender as the main risk factor for recurrence,28 Huang et al. They suggested that CAU alone seems to be a proper surgical choice for the treatment of recurrent pterygia; however, combining it with AMT provides a good surgical alternative in cases where little conjunctival donor tissue is available.6 There is controversial evidence that LCAU is more effective than CAU for treatment of recurrent pterygium. With a 12-month follow-up, no difference was found in terms of the healing time for epithelial defect, conjunctival inflammation grade, or the frequency of complications. Nuhoglu F, Turna F, Uyar M, Ozdemir FE, Eltutar K. Is there a relation between histopathologic characteristics of pterygium and recurrence rates? MMC was used as an adjuvant in both groups. Ono T, Mori Y, Nejima R, Tokunaga T, Miyata K, Amano S. Long-term follow-up of transplantation of preserved limbal allograft and amniotic membrane for recurrent pterygium. It's best to approach pterygium surgery with the goal of reducing the chances of recurrence at all costs. Your eye doctor makes a formal diagnosis following a slit-lamp examination that allows close-up observation of the lesion under magnification. between intraoperative and postoperative appli- Reda et al. Olusanya BA, Ogun OA, Bekibele CO, Ashaye AO, Baiyeroju AM, Fasina O, et al. Recurrent Pterygium | Vagelos College of Physicians and Surgeons evaluated the differences in tear film parameters between pterygium-affected and healthy eyes. Some authors believe that subconjunctival injection of MMC before the operation helps with the exact titration of drug delivery to the activated fibroblasts and minimizes corneal epithelial toxicity.73 Khalifa et al. There is a lack of consensus among ophthalmologists about the optimal medical and surgical management of pterygia. Ocular demodicosis as a potential cause of pediatric blepharoconjunctivitis. Hovanesian J, Starr C, Vroman D, Mah F, Gomes J, Farid M, et al. Pterygium: an update on pathophysiology, clinical features, and The mean postoperative follow-up period was 26.4 14.5 months (range: 12-60 months). Rest assured, pterygium is a benign (non-cancerous) lesion that does not spread beyond the surface of the eye. Kasetsuwan N, Reinprayoon U, Satitpitakul V. Prevention of recurrent pterygium with topical bevacizumab 0.05% eye drops: A randomized controlled trial. However, initial studies of postoperative MMC drops reported higher risk of complications and therefore are rarely used nowadays.15,59,62 The more the MMC is exposed to bare sclera, the more the likelihood of MMC-induced complications, which may include scleritis, secondary glaucoma, corneal edema, corneal perforation, corectopia, iritis, sudden-onset mature cataract, scleral calcification, incapacitating photophobia, and pain.10,58,62 Some of these complications occur later in the follow-up period. Khalfaoui T, Mkannez G, Colin D, Imen A, Zbiba W, Errais K, et al. Ratnalingam V, Eu AL, Ng GL, Taharin R, John E. Fibrin adhesive is better than sutures in pterygium surgery. A better understanding of the recurrence risk factors may lead to a better prophylaxis plan and better medical or surgical treatment. Gumus K, Karakucuk S, Mirza GE, Akgun H, Arda H, Oner AO. study, multiple weekly subconjunctival intralesional 5-FU injections, 0.10.2 ml (2.55.0 mg) started within 1 month of recurrence, have been shown to be safe and effective in halting the progression and inducing regression of recurrent pterygium.19 Another study assessed the changes in pathological parameters of the ocular surface before and after 10 intralesional injections of 5-FU in recurrent pterygium cases.49 They reported an increase in the number of epithelial cells and density of goblet cells, reduction in the squamous metaplasia, and changing in abnormal cytology to normal in these injected eyes. Among proposed risk factors, DED, black race, and young age are considered preoperative risk factors for recurrence.1,2,3,4,5,6,7,8 Some molecular biomarkers and genetic factors have also been considered to increase the risk of recurrence. In another study by Toker et al., patients were followed up for one year, as nearly all postoperative recurrences occurred within that time.12 This was in agreement with another study showing that 87.5% of recurrences happened in the first postoperative year.17 In a study using preserved limbal allograft and amniotic membrane transplantation (AMT) for recurrent pterygium by Ono et al., the results showed that the mean period to recurrence was 16.3 months (range, 533 months) after surgery.53 The authors reinforced that the recurrence rate in the previous studies would have been much higher if the follow-up period was long enough. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary.