Pterygium

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Summary of Evidence

Surgical technique

Conjunctival autograft vs amniotic membrane transplantation

 

Analysis of 20 studies involving 1947 eyes of 1866 patients concluded that in association with pterygium excision, conjunctival autograft is associated with a lower risk of recurrence at six months’ after surgery than amniotic membrane transplant, especially in patients with recurrent pterygia. {Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016 Feb 11;2:CD011349.}

 

Fibrin glue vs sutures

 

Analysis of 14 RCTs showed fibrin glue may result in less recurrence (risk ratio 0.47) and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery, but may result in more complications (risk ratio 1.92) such as graft dehiscence, graft retraction and granuloma. {Romano V, Cruciani M, Conti L, Fontana L. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. Cochrane Database Syst Rev. 2016 Dec 2;12(12):CD011308.}

 

Adjuvant Cyclosporine A

 

Meta-analysis of 7 studies showed that adjuvant use of Cyclosporine A (CsA) can significantly reduce the risk of pterygium recurrence compared with pterygium excision alone, whereas adjuvant use of CsA may not reduce the risk of pterygium recurrence in pterygium excision + limbal conjunctival autograft or conjunctival flap rotation. {Zhang Q, Bao N, Liang K, Tao L. Adjuvant Use of Cyclosporine A in the Treatment of Primary Pterygium: A Systematic Review and Meta-Analysis. Cornea. 2018 Aug;37(8):1000-1007.}

Evidence

1. Background

1.1 Prevalence

Review

2018 Rezvan et.al.

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2018
Review

Analysis of 68 articles with a total of 415,911 participants to determine the global prevalence and risk factors for pterygium. {Rezvan F, Khabazkhoob M, Hooshmand E, Yekta A, Saatchi M, Hashemi H. Prevalence and risk factors of pterygium: a systematic review and meta-analysis. Surv Ophthalmol. 2018 Sep-Oct;63(5):719-735.}

cited by count
Review

2017 Song et.al.

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2017
Review

The overall prevalence of pterygium in China in individuals aged 15-84 years was 9.84%. {Song P, Chang X, Wang M, An L. Variations of pterygium prevalence by age, gender and geographic characteristics in China: A systematic review and meta-analysis. PLoS One. 2017 Mar 29;12(3):e0174587.}

1.2 Risk factors

Review

2018 Rezvan et.al.

Article link | Metrics cited by count

2018
Review

Analysis of 68 articles with a total of 415,911 participants to determine the global prevalence and risk factors for pterygium. {Rezvan F, Khabazkhoob M, Hooshmand E, Yekta A, Saatchi M, Hashemi H. Prevalence and risk factors of pterygium: a systematic review and meta-analysis. Surv Ophthalmol. 2018 Sep-Oct;63(5):719-735.}

cited by count
Review

2014 Rong et.al.

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2014
Review

Analysis of 24 articles incorporating 95,279 participants showed cigarette smoking was associated with a reduced risk of pterygium, especially in current smokers (Odds ratio 0.82). {Rong SS, Peng Y, Liang YB, Cao D, Jhanji V. Does cigarette smoking alter the risk of pterygium? A systematic review and meta-analysis. Invest Ophthalmol Vis Sci. 2014 Sep 4;55(10):6235-43.}

2. Surgical treatment

2.1 Surgical technique

2.1.1 Conjunctival autograft

Review

2017 Clearfield et.al.

Article link | Metrics cited by count

2017
Review

Analysis of 20 studies involving 1947 eyes of 1866 patients showed that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group. For recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT. {Clearfield E, Hawkins BS, Kuo IC. Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review. Am J Ophthalmol. 2017 Oct;182:8-17.}

cited by count
Review

2016 Clearfield et.al.

Article link | Metrics cited by count

2016
Review

Analysis of 20 studies involving 1947 eyes of 1866 patients concluded that in association with pterygium excision, conjunctival autograft is associated with a lower risk of recurrence at six months’ after surgery than amniotic membrane transplant, especially in patients with recurrent pterygia. {Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016 Feb 11;2:CD011349.}

cited by count

2.1.2 Sutures vs fibrin glue for conjunctival autograft

Review

2016 Lotfy et.al.

Article link | Metrics cited by count

2016
Review

Analysis of 14 RCTs showed fibrin glue may result in less recurrence (risk ratio 0.47) and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery, but may result in more complications (risk ratio 1.92) such as graft dehiscence, graft retraction and granuloma. {Romano V, Cruciani M, Conti L, Fontana L. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. Cochrane Database Syst Rev. 2016 Dec 2;12(12):CD011308.}

cited by count

2.1.3 Adjuvant Mitomycin C injection

Clinical trial

2018 Sul et.al.

Article link | Metrics cited by count

2018
Clinical trial

Both preoperative (1-day) Mitomycin C injection and intraoperative local application of MMC on the medial rectus tendon in pterygium excision with conjunctival autograft are successful in treating primary pterygium with low recurrence rate and few complications. {Lotfy A, Gad AAM, Abdelrahman A, Samir A, Abdulhalim BH. Conjunctival Autograft Combined With Either Preoperative Mitomycin C Injection or Intraoperative Local Mitomycin C Over the Medial Rectus Muscle Tendon in Primary Pterygium Surgery. Eye Contact Lens. 2018 Nov;44 Suppl 2:S192-S195.}

2.2 Adjuvant Cyclosporine A

Review

2018 Zhang et.al.

Article link | Metrics cited by count

2018
Review

Meta-analysis of 7 studies showed that adjuvant use of Cyclosporine A (CsA) can significantly reduce the risk of pterygium recurrence compared with pterygium excision alone, whereas adjuvant use of CsA may not reduce the risk of pterygium recurrence in pterygium excision + limbal conjunctival autograft or conjunctival flap rotation. {Zhang Q, Bao N, Liang K, Tao L. Adjuvant Use of Cyclosporine A in the Treatment of Primary Pterygium: A Systematic Review and Meta-Analysis. Cornea. 2018 Aug;37(8):1000-1007.}

cited by count

2.3 Adjuvant autologous serum eyedrops

Clinical trial

2018 Sul et.al.

Article link | Metrics cited by count

2018
Clinical trial

Autologous serum drops accelerated corneal epithelial healing and decreased pain following pterygium surgery. {Sul S, Korkmaz S, Alacamli G, Ozyol P, Ozyol E. Application of autologous serum eye drops after pterygium surgery: a prospective study. Graefes Arch Clin Exp Ophthalmol. 2018 Oct;256(10):1939-1943.}

2.4 Adjuvant interferon alpha-2b eyedrops

Clinical trial

2019 Yin et.al.

Article link | Metrics cited by count

2019
Clinical trial

Administration of IFN alpha-2b eye drops after the bare sclera technique appear safe and effective in reducing the recurrence of pterygium. {Yin M, Li H, Zhang Y, Dai H, Luo F, Pan Z. Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. Cornea. 2019 Oct;38(10):1239-1244.}

References

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