Does Choice of Different Surgical Intervention Play a Role in the Recurrence of Pterygium?

Abstract

Background There are a wide range of pterygium excision techniques in practice. However, choosing the best possible option is an important factor to prevent its recurrence. Objective To compare the recurrence rate of different excision techniques and understand if a surgeon can alter the recurrence rate. Method A retrospective data of pterygium surgeries operated by a surgeon at Sagarmatha Choudhary Eye Hospital, Nepal from the year 2016 to 2018 was investigated for recurrence. The recurrence was measured by an independent Optometrist with the help of clinical photo and slit-lamp examination. A telephonic directory was maintained for every patient's follow up reminder. Result Altogether 916 individuals with mean age 56.20 years had undergone pterygium excision. Bare Sclera 280 (30.56%), Pterygium Extended Conjunctival Transplantation (PERFECT) 305 (33.29%), Conjunctival auto graft (CAG) 262 (28.60%), Simple Pterygium excision 60 (6.55%) and Amniotic Membrane Graft (AMG) 9 (0.98%), jointly formed the total study sample and surgical techniques. Recurrence for Bare sclera was 172 (61.42%), simple pterygium excision 34 (56.66%), Pterygium extended conjunctival transplantation 0 (0%), and conjunctival auto graft 2 (0.76%). Compared conjunctival auto graft with pterygium extended conjunctival transplantation and simple pterygium with bare sclera revealed similar recurrence rate comparatively. The p-value obtained were p = 0.2148 and p = 0.8152 (p > 0.05, 95% CI) respectively. Conclusion The loss of limbal stem cells in Bare sclera technique acts as stimulant for pterygium recurrence, in addition the remains of pterygial matter in simple pterygium excision acts as precursor for recurrence. Pterygium extended conjunctival transplantation indeed acts as barrier but needs fine surgical skills to perform. Conjunctival auto graft can be opted as an alternative technique for minimal recurrence as compared to Pterygium extended conjunctival transplantation.