Pterygium Literature Summary:
The following studies used cryopreserved amnion graft transplantation for conjunctival surface reconstruction following removal of primary pterygium. For primary pterygium, Prabhasawat et al (1) first compared a prospective study using amnion grafts (n=54) to a retrospective study using conjunctival grafts (n=122) in both primary and recurrent pterygium. This study conducted in 1997 noted that the recurrence rate is 10.9% using amnion grafts, which is higher than 2.6% of conjunctival grafts. Nevertheless, both results of amnion grafts and conjunctival grafts are significantly better than the primary closure (n=20), which resulted in 45% high recurrence rate for primary pterygium. Kim et al (2) reported a recurrence rate of 18% in 11 primary pterygium (using amnion grafts alone).
In 2001, Solomon et al (3) reported that by incorporating a larger removal of subconjunctival fibrous tissue and injection of long-acting steroid (Kenalog), amnion grafts achieved a lower recurrence rate of 3.0%, compatible with 2.6% of conjunctival autografts published by Prabhasawat et al1. Ma et al (4) reported 3.7% recurrence rate in 80 eyes using amnion grafts alone, which is compatible with 5.4% of 56 eyes with conjunctival grafts alone, and 3.7% of 54 eyes with topical mitomycin C alone for primary pterygium.
It should be noted that the surgical method proposed here differs from the above in combining both amnion grafts and intraoperative application of MMC (to fornix) and in using fibrin glue (without sutures) measures collectively furthering the success and the ease of care. This new strategy is based on the following literature:
Intraoperative application of mitomycin C (0.04% for 5 min) to the fornix (not the bare sclera) is used as an adjunctive treatment to reduce chronic conjunctival inflammation and augment the efficacy of AMT in restoring a deep fornix after symblepharon lysis (5,6) and together with AMT and conjunctival autograft to restore ocular motility in multi-recurrent pterygia (7,8).
References:
1. Prabhasawat P, Barton K, Burkett G, Tseng SCG. Comparison of conjunctival autografts, amniotic membrane grafts and primary closure for pterygium excision. Ophthalmology. 1997;104:974-985.
2. Kim JC, Lee D, Shyn KH. Clinical uses of human amniotic membrane for ocular surface diseases. In: Lass JH, ed. Advances in Corneal Research. New York: Plenum Press; 1997:117-134.
3. Solomon A, Pires RTF, Tseng SCG. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology. 2001;108:449-460.
4. Ma DH-K, See L-C, Liau S-B, Tsai RJF. Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol. 2000;84:973-978.
5. Tseng SCG, Di Pascuale MA, Liu D-Z, GAO Y-Y, Baradaran-Rafii A. Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocualr surface diseases. Ophthalmology 2005;112:896-903.
6. Nava-Castaneda A, Tovila-Canales JL, Monroy-Serrano MH, Tapia-Guerra V, Tovilla YPJ, Ordonez-Blanco A, Garnica-Hayashi L, Garfias-Becerra Y. [Comparative study of amniotic membrane transplantation, with and without simultaneous application of mitomycin C in conjunctival fornix reconstruction]. Arch Soc Esp Oftalmol 2005;80:345-352.
7. Sangwan VS, Murthy SI, Bansal AK, Rao GN. Surgical treatment of chronically recurring pterygium. Cornea 2003;22:63-65.
8. Yao YF, Qiu WY, Zhang YM, Tseng SC. Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. Graefes Arch Clin Exp Ophthalmol 2005;1-5.
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