BAGIAN ILMU KESEHATAN MATA JOURNAL READING

FAKULTAS KEDOKTERAN APRIL 2022

UNIVERSITAS PATTIMURA

PTERIGIUM: EPIDEMIOLOGI, PENCEGAHAN DAN PENGOBATAN

Disusun Oleh:

Elisabeth Sabatini Fatlolon

NIM. 2022-84-038

Pembimbing:

dr. Elna Anakotta, Sp.M

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

ILMU KESEHATAN MATA

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

AMBON

2022

1
Epidemiologi

Pterygium adalah gangguan degeneratif konjungtiva. Hal ini biasanya terlihat sebagai

proliferasi fibrovaskular berdaging segitiga dari konjungtiva bulbar ke kornea, sebagian

besar terletak di sisi hidung. Meskipun terjadi di seluruh dunia, prevalensinya tinggi di

“pterygium belt” antara 30 derajat utara dan 30 derajat selatan khatulistiwa . Prevalensi

pterygium dilaporkan 3% pada orang Australia, 23% pada orang kulit hitam di Amerika

Serikat, 15 % pada orang Tibet di Cina, 18% pada orang Mongolia di Cina, 30% pada

orang Jepang dan 7% pada orang Cina Singapura dan India.2-7 Dalam studi berbasis

populasi dari pedesaan India tengah, prevalensi pterigium meningkat dari 6,7 ± 0,8% pada

kelompok umur 30-39 tahun menjadi 25,3±2,1% pada kelompok umur 70-79 tahun. Tiga

studi berbasis populasi telah menggambarkan kejadian pterigium. Studi mata Barbados

menggambarkan insiden pterygium sembilan tahun menjadi 11,6% (95% CI,10.1-13.1),

Studi Mata Beijing menggambarkan insiden pterygium 10 tahun pada populasi Cina

dewasa menjadi 4,9%, dan lima kejadian kumulatif tahun pada populasi Cina Bai di

komunitas pedesaan adalah 6,8% (95% CI, 5,2-8,4).

Faktor risiko dan patogenesis

Studi berbasis populasi ini menunjukkan bahwa paparan sinar ultraviolet kumulatif

karena pekerjaan di luar ruangan merupakan faktor risiko utama untuk perkembangan

pterigium. Faktor lain yang terkait dengan perkembangan pterigium adalah usia, laki-laki

dan memiliki mata kering.11-13 Faktor genetik, gen penekan tumor p53 dan gen lain

mungkin terlibat dalam patogenesis pterigium.14 Sebuah studi menunjukkan hipotesis dua

tahap untuk patogenesis pterigium: gangguan awal penghalang limbus dan "konjungsi

2
valisasi" aktif progresif kornea.15 Identifikasi Fuchs Flek di kepala pinguecula, pterygium

primer, pterygium berulang, dan limbus nasal dan temporal yang normal secara

makroskopis dapat mewakili lesi prekursor ke patologi permukaan okular terkait UV.16

Pencegahan

Menghindari faktor risiko lingkungan seperti sinar matahari, angin dan debu dengan

memakai sinar UV yang melindungi kacamata hitam dan topi dapat mencegah

perkembangan pterigium. Tindakan perlindungan ini dapat membantu mencegah

kekambuhan pterigium setelah operasi. Demikian pula, pemakaian peralatan keselamatan

mata direkomendasikan di lingkungan yang terpapar polutan kimia sebagai tindakan

pencegahan pterygium.

Indikasi Pembedahan

Indikasi utama pembedahan pterigium adalah gangguan penglihatan sekunder akibat

perambahan pada area pupil atau induksi astigmatisme. Indikasi lain yang dapat

dipertimbangkan adalah, pembatasan gerakan mata, kemerahan kronis dan sensasi benda

asing, dan masalah kosmetik.17

Penatalaksanaan

Pembedahan merupakan pengobatan andalan untuk pterigium yang menyebabkan

gangguan penglihatan. Komplikasi utama dari operasi pterygium adalah kekambuhan

didefinisikan oleh pertumbuhan kembali jaringan fibrovaskular di limbus dan ke kornea.

Tidak ada keseragaman pendapat mengenai prosedur eksisi pterygium yang ideal terkait

3
dengan tingkat kekambuhan terendah. Teknik Bare sclera, yang banyak digunakan di

negara berkembang untuk kemudahan dan kecepatan operasi, dikaitkan dengan tingkat

kekambuhan yang tinggi.18 Terapi tambahan lain yang dikombinasikan dengan teknik bare

sclera telah secara signifikan mengurangi tingkat kekambuhan (2% sampai 15% ).19

Penerapan agen yang berbeda seperti Strontium 90, iradiasi Beta dan obat sitotoksik seperti

Mitomycin-C dan 5- Fluorouracil ke tempat tidur sklera telah dicoba tetapi komplikasi

yang mengancam penglihatan seperti skleritis inflamasi, skleromalasia dan kehilangan

mata telah terjadi kadang-kadang dilaporkan.20

Transplantasi membrane amnion telah digunakan setelah teknik bare sclera dengan

tingkat kekambuhan yang dilaporkan 4% hingga lebih dari 60%.21,22 Saat ini, prosedur

yang paling banyak digunakan adalah eksisi pterigium dengan autograft konjungtiva.23

Konjungtiva bulbar superior telah digunakan secara luas sejak awal 1980-an dan dikaitkan

dengan tingkat kekambuhan sekitar 2% sampai 12% bersama dengan beberapa

komplikasi.24-26 Pada 1980-an, Barraquer memperkenalkan konsep bahwa pengangkatan

lapisan Tenon mungkin penting dalam mengurangi tingkat kekambuhan setelah

pengangkatan pterigium karena duri adalah sumber utama fi bro blast.27 Hal ini juga

ditekankan oleh Solomon et al yang menggabungkan teknik ini dengan aplikasi

Mitomycin-C dan transplantasi membran amnion untuk mencapai tingkat kekambuhan

yang rendah.28 Tingkat kekambuhan mendekati nol dengan hasil estetika yang baik dapat

dicapai dengan menggunakan Pterygium Extended Removal Followed by Extended

Conjunctival Transplantation (PERFECT).29-31 Tidak ada teknik yang ideal untuk

autograft konjungtiva yang aman, cepat, mudah dan murah. Berbagai metode seperti

jahitan, lem fibrin, serum autologus dan elektrokauter telah digunakan untuk autografting

4
konjungtiva.32,33 Langkah bedah untuk eksisi pterigium dengan autograft konjungtiva

yang telah kami adopsi di rumah sakit kami di bawah Program Perawatan Mata Regional

Timur di bagian timur di Nepal adalah sebagai berikut:

Anestesi: Anestesi peribulbar lebih disukai daripada anestesi topikal atau subkonjungtiva

untuk menghindari rasa sakit selama operasi dan untuk mendapatkan prosedur pembedahan

yang lancar.

Eksisi pterigium: Badan pterigium dieksisi secara hati-hati dengan gunting konjungtiva

dan kepala pterigium dapat diangkat dari kornea dengan menggunakan pisau Bard Parker

15 derajat.

Duri dan jaringan subtenon harus diangkat dengan hati-hati sebanyak mungkin. Jaringan

pterygium yang tersisa dari atas permukaan kornea dapat dihilangkan dengan diamond

burr.

Persiapan autograft konjungtiva: Cacat konjungtiva yang dihasilkan oleh eksisi

pterigium harus diukur dengan caliper dan konjungtiva bulbar superior harus ditandai

dengan penanda. Itu selalu lebih baik untuk menggunakan penanda untuk membuat ukuran

cangkokan yang persis sama. Setelah penandaan, injeksi normal saline subkonjungtiva,

sekitar 2 ml, disuntikkan pada konjungtiva bulbar superior untuk membuat balon
5
konjungtiva. Lapisan tipis cangkok konjungtiva, tanpa duri dan jaringan subtenon

disiapkan.

Pencangkokan konjungtiva: Pencangkokan konjungtiva tipis ditempatkan dengan

orientasi yang benar pada area cacat konjungtiva yang dibuat oleh eksisi pterigium.

Penanda membantu mengidentifikasi orientasi cangkok yang benar.

Cangkok konjungtiva dapat dijahit dengan jahitan Vicryl 8'0 atau Nylon 10'0 atau dapat

direkatkan dengan lem fibrin.

Pencangkokan konjungtiva dengan lem fibrin adalah prosedur yang lebih cepat dan pasien

mengeluhkan nyeri yang berkurang pada periode pasca operasi.

Penatalaksanaan pasca operasi: Tetes mata antibiotik dan steroid diberikan dalam dosis

yang dikurangi selama satu bulan.

Kesimpulan

Banyak dokter mata berpikir bahwa pterygium adalah kondisi sepele yang tidak banyak

waktu yang harus dikeluarkan dalam operasi dan remunerasi keuangan yang rendah.34

Tetapi pasien menginginkan penyembuhan, bebas dari kekambuhan dengan kosmetik yang

6
baik setelah operasi. Eksisi pterygium dengan autograft konjungtiva dengan lem fibrin

menawarkan tingkat kekambuhan yang rendah, hasil kosmetik yang baik dengan kecepatan

operasi pterygium yang wajar.

7
 REFERENSI

1. Detels R, Dhir SP, Pterygium: a geographical study. Arch Ophthalmol. 1967;78: 485-

491.

2. McCarty CA, Fu CL, Taylor HR. Epidemiology of Pterygium in Victoria, Australia.

Br J Ophthalmology. 2000;84:289-292.

3. Luthra R, Nemesure BB, Wu SY, et al. Frequency and Risk Factors for Pterygium in

the Barbados Eye Study. Arch Ophthalmology. 2001;119:1827- 1832.

4. Lu P,Chen X, Kang Y, et al. Pterygium in Tibetans: a population-based study in China.

Clin Experiment Ophthalmol. 2007;35:828-833.

5. Lu J, Wang Z, Lu P, et al. Pterygium in an aged Mangolian Population: a population

based study in China. Eye (Lond) 2009;23:421-427.

6. Shirma H, Higa A, Sawaguchi S, et al. Prevalence and risk factors of Pterygium in

southwestern island of Japan: the Kumejima Study. Am J Ophthalmolo. 2009;148:766-

771.e761.

7. Ang M, Li X, Wong W, eta al. Prevalence of and racial diff erences in pterygium a

multiethnic population study in Asians. Ophthalmology. 2012;119:1509-1515.

8. Nemesure B, Wu SY,Hennis A et al. Nine-year incidence and risk factors for pterygium

in the Barbados eye studies. Ophthalmology. 2008;115:2153-2158.

9. Zhao L,You QS, Xu L, et al. 10 year incidence and association of Pterygium in adult

Chinese: the Beijing Eye Study. Invest Ophthalmol Vis Science. 2013; 54:1509-1514.

10. Lan Li, Hua Zhong, Ermio Tian et al.Five-Year Incidence and Predictors for Pterygium

in a Rural Community in China: The Unnan Minority Eye Study.

Cornea.2015;34:1564-1568.

8
11. Wong TY, Foster PJ, Johnson GJ, et al. The Prevalence and risk factors for pterygium

in an adult Chinese population in Singapore: the Tanjong Pagar survey. Am J

Ophthalmol. 2001;131:176-183.

12. Saw SM, Banerjee K, Tan D. Risk factors for the development of pterygium in

Singapore: a hospitalbased case control study. Acta Ophthalmol Scand. 2000;78:216-

220.

13. Ishioka M, Shimmura S, Yagi Y et al. Pterygium and dry eye. Ophthalmologica.

2001:215:209- 211.

14. Liu T, Liu Y, Xie L, et al. Progress in the pathogenesis of pterygium. Current Eye Res.

2013;38:1191-1197.

15. M.T.Coroneo, N. Di Girolamo and D. Wakeeld. The pathogenesis of pterygia. Current

Opinion in Ophthalmology. 1999;10:282-288.

16. Matthew H. Ip, Jeanie J Chui, Lien Tat and Minas T. Coroneo. Signifi cance of Fuchs

Flecks in Patients With Pterygium/ Pinguecula: Earliest Indicator of Ultraviolet Light

Damage. Cornea. 2015;34:1560- 1563.

17. Lawrence W. Hirst. The Treatment of Pterygium. Survey of Ophthalmology.

2003;48:2: 145-179.

18. Lawrence W.Hirst. Prospective Study of Primary Pterygium surgery using Pterygium

Extended Removal Followed by Extended Conjunctival Transplantation.

Ophthalmology. 2008;115:1663- 1672.

19. Simsek T, Gunlap I, Atilla H. Comparative effi cacy of beta irradiation and mitomycin-

C in primary and recurrent pterygium. Eur J Ophthalmol. 2001;11:126-132.

9
20. Dougherty PJ, Hardten DR, Lindstrom RL. Corneoscleral melt after pterygium surgery

using a single intraoperative application of mitomycin-C. Cornea. 1996;15:537-540.

21. Ma DH, See LC, Liau SB, Tsai RJ. Amniotic Membrane graft for primary pterygium:

comparison with conjunctival autograft and topical mitomycin C treatment. Br J

Ophthalmol. 2000;84:973-978.

22. Essex RW, Snibson GR, Daniell M, Tole DM. Amniotic membrane grafting in the

surgical management of primary pterygium. Clin. Experiment Ophthalmol.

2004;32:501-504.

23. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for

advanced and recurrent pterygium. Ophthalmology. 1985;92:1461-1470.

24. Young AL, Leung GY,Wong AK et al. A randomized trial comparing 0.02%

mitomycin-C and limbal conjunctival autograft after excision of primary pterygium.Br

J Ophthalmol. 2004;88:995-997

25. Mejia LF, Sanchez JG, Escobar H. Management of primary pterygia using free

conjunctival and limbalconjunctival autografts without antimetabolites. Cornea.

2005;24:972-975.

26. Fernandes M, Sangwan VS, Bansal AK et al. Outcome of pterygium surgery: analysis

over 14 years. Eye. 2005;19:1182-1190.

27. Barraquer JI. Etiology, pathogenesis and treatment of the pterygium. Trans New

Orleans Acad Ophthalmol. 1980;167-178.

28. Solomon A,Pires RT, Tseng SC. Amniotic membrane transplantation after extensive

removal of primary and recurrent pterygia. Ophthalmology. 2001;108:449-460.

10
29. Hirst LW. Prospective study of Primary Pterygium Surgery using Pterygium Extended

Removal Followed by Extended Conjunctival Transplantation. Ophthalmology.

2008;115:1663-1672.

30. Hirst LW. Cosmesis after Pterygium extended removal followed by extended

conjunctival transplantation as assessed by a new, web-based grading system.

Ophthalmology. 2011;118:1739- 1746.

31. Hirst LW. Pterygium Extended Removal Followed by Extended Conjunctival

Transplantation: But on which eye? Cornea. 2013;32:799-802.

32. Vanitha Ratnalingam, Andrew Lim Keat Eu, Gem Leong et al. Fibrin Adhesive is

Better Than Sutures in Pterygium Surgery. Cornea.2010;29:485-489.

33. Fan Xu, Min Li, Yumei Yan et al. A Novel Technique of Sutureless and Glueless

Conjunctival Autografting in Pterygium Surgery by Electrocautery Pen.

Cornea.2013;32:290-295.

34. Essex RW, Snibson GR, Daniell M et al. Amniotic Membrane grafting in the surgical

management of primary pterygium. Clin Experiment Ophthalmol. 2004;32:501-504

11
 FROM OUR SOUTH ASIA EDITION

Pterygium: epidemiology prevention

and treatment
cation of Fuchs Flecks at the head of tation has been used after bare sclera
Prof Dr Sanjay Kumar pinguecula, primary pterygium, recur- technique with a reported recurrence
Singh rent pterygium, and macroscopically rate of 4% to more than 60%.21,22
Director, Eastern Regional Eye
Care Programme, Biratnagar, normal nasal and temporal limbus Currently, the most widely used
Nepal. may represent precursor lesions to procedure is pterygium excision with
UV associated ocular surface pathol- conjunctival autograft.23 Superior
Epidemiology ogy.16 bulbar conjunctiva has been used
Pterygium is a degenerative disorder widely since the early 1980s and is
of the conjunctiva. It is usually seen Prevention associated with recurrence rate of
as a triangular fleshy fibrovascular Avoidance of environmental risk approximately 2% to 12% along with
proliferation from the bulbar con- factors like sunlight, wind and dust by few complications.24-26 In the 1980s,
junctiva onto the cornea, located wearing UV rays protecting sunglass- Barraquer introduced the concept
mostly on the nasal side. Though it es and hat may prevent development that removal of Tenon’s layer may
occurs worldwide, its prevalence is of pterygium. These protective meas- be important in reducing recurrence
high in the “pterygium belt” between ures may help to prevent recurrence rate after pterygium removal as the
30 degrees north and 30 degrees of pterygium after surgery. Similarly, tenon is the main source of fibro-
south of the equator.1 The prevalence wearing of eye safety equipment blasts.27 This was also emphasised
of pterygium is reported to be 3% in is recommended in environment by Solomon et al who combined this
Australians, 23% in blacks in United exposed to chemical pollutants as a technique with Mitomycin-C applica-
States, 15% in Tibetans in China, 18% preventive measure for pterygium. tion and amniotic membrane trans-
in Mongolians in China, 30% in Japa- plantation to achieve a low recur-
rence rate.28 A near zero recurrence
nese and 7% in Singaporean Chinese Indication for surgery rate with a good aesthetic result
and Indians.2-7 The main indication for pterygium
In a population-based study from can be achieved by using Pterygium
surgery is visual disturbance sec-
rural central India, prevalence of Extended Removal Followed by Ex-
ondary to encroachment over the
pterygium increased from 6.7±0.8% tended Conjunctival Transplantation
pupillary area or induced astigma-
in the age group from 30-39 years (P.E.R.F.E.C.T.).29-31 There is no ideal
tism. Other indications which can
to 25.3±2.1% in the age group of technique for conjunctival autograft-
be considered are, restriction in eye
70-79 years. Three population based ing which is safe, fast, easy and inex-
movements, chronic redness and
studies have described the incidence pensive. Various methods such as
foreign body sensation, and cosmetic
of pterygium. Barbados eye study has sutures, fibrin glue, autologous
concerns.17
described the nine year incidence of serum and electrocautery have been
pterygium to be 11.6% (95% CI,10.1- used for conjunctival autografting.32,33
13.1), the Beijing Eye Study described
Management Surgical steps for pterygium excision
Surgery is the mainstay of treatment with conjunctival autograft that we
the 10 year incidence of pterygium
for pterygium causing visual distur- have adopted at our hospitals under
in the adult Chinese population to be
bances. The primary complication Eastern Regional Eye Care Pro-
4.9%, and the five year cumulative
of pterygium surgery is recurrence gramme in the eastern part of Nepal
incidence in Bai Chinese population
defined by regrowth of fibrovascular are as follows:
in a rural community was 6.8%
tissue across the limbus and onto Anaesthesia: Peribulbar anaesthe-
(95% CI, 5.2-8.4). 8-10
the cornea. No uniformity of opinion sia is preferable over the topical or
exists regarding the ideal pterygium subconjunctival to avoid pain during
Risk factors and pathogen- excision procedure associated with operation and to have smooth surgi-
esis lowest recurrence rate. Bare sclera cal procedure.
These population-based studies sug- technique, which is widely used in the
(c) Sanjay Kumar Singh/ Eastern Regional Eye Care Programme, Nepal

gest that cumulative ultraviolet light developing world for the ease and
exposure due to outdoor occupation speed of surgery, is associated with
is a major risk factor for the devel- high recurrence rates.18 Other adjunc-
opment of pterygium. Other factors tive therapies combined with bare
associated with pterygium develop- sclera technique have significantly
ment are age, being male and having reduced the recurrence rate (2% to
dry eyes.11-13 Genetic factors, tumor 15%).19 Application of different agents
suppressor gene p53 and other genes like Strontium 90, Beta irradiation
may be involved in the pathogenesis and cytotoxic drugs like Mitomycin-C
of pterygium.14 and 5-Fluorouracil to the scleral bed
A study indicated a two-stage hypoth- have been tried but sight threaten-
Figure 1. A diamond burr is used for
esis for pterygium pathogenesis: ing complications like inflammatory
smoothening of corneal surface
initial disruption of the limbal barrier scleritis, scleromalacia and loss of the
and progressive active “conjuncti- eye have been occasionally report-
valisation” of the cornea.15 Identifi- ed.20 Amniotic membrane transplan- Continues overleaf ➤

© The author/s and Community Eye Health Journal 2018. This is an Open Access
article distributed under the Creative Commons Attribution Non-Commercial License.
COMMUNITY EYE HEALTH JOURNAL | VOLUME 29 | ISSUE 99 | 2017 S5

OSD indexing_LB1.indd 5 25/04/2018 18:42

 FROM OUR SOUTH ASIA EDITION
Pterygium excision: Pterygium body
is excised carefully with conjunctival
scissors and the head of pterygium
can be removed from cornea by
using a 15 degree Bard Parker blade.
Tenons and subtenon tissue must be
removed carefully as much as possi-
ble. Remaining pterygium tissues
from over the corneal surface can be
removed with a diamond burr.
Conjunctival autograft prepara-
tion: The conjunctival defect created
by pterygium excision should be
measured with a caliper and the
superior bulbar conjunctiva should
be marked by a marker. It is always
preferable to use the marker to
create exactly the same size of the
graft. After marking, a subconjuctival
injection of normal saline, around 2
ml, is injected on the superior bulbar
conjunctiva to create the conjunctival
balloon. A thin layer of conjunctival
graft, devoid of tenons and subtenon
tissue is prepared.
References
1 Detels R, Dhir SP, Pterygium: a geographical study. Arch
Ophthalmol. 1967;78: 485-491.
2 McCarty CA, Fu CL, Taylor HR. Epidemiology of Pterygium in
Victoria, Australia. Br J Ophthalmology. 2000;84:289-292.
3 Luthra R, Nemesure BB, Wu SY, et al. Frequency and Risk
Factors for Pterygium in the Barbados Eye Study. Arch
Ophthalmology. 2001;119:1827- 1832.
4 Lu P,Chen X, Kang Y, et al. Pterygium in Tibetans: a
population-based study in China. Clin Experiment
Ophthalmol. 2007;35:828-833.
5 Lu J, Wang Z, Lu P, et al. Pterygium in an aged Mangolian
Population: a population based study in China. Eye (Lond)
2009;23:421-427.
6 Shirma H, Higa A, Sawaguchi S, et al. Prevalence and risk
factors of Pterygium in southwestern island of Japan: the
Kumejima Study. Am J Ophthalmolo. 2009;148:766-771.e761.
7 Ang M, Li X, Wong W, eta al. Prevalence of and racial
differences in pterygium a multiethnic population study in
Asians. Ophthalmology. 2012;119:1509-1515.
8 Nemesure B, Wu SY,Hennis A et al. Nine-year incidence and
risk factors for pterygium in the Barbados eye studies.
Ophthalmology. 2008;115:2153-2158.
9 Zhao L,You QS, Xu L, et al. 10 year incidence and association of
Pterygium in adult Chinese: the Beijing Eye Study. Invest
Ophthalmol Vis Science. 2013; 54:1509-1514.
10 Lan Li, Hua Zhong, Ermio Tian et al.Five-Year Incidence and
Predictors for Pterygium in a Rural Community in China: The
Unnan Minority Eye Study. Cornea.2015;34:1564-1568.
11 Wong TY, Foster PJ, Johnson GJ, et al. The Prevalence and risk
factors for pterygium in an adult Chinese population in
Singapore: the Tanjong Pagar survey. Am J Ophthalmol.
2001;131:176-183.
12 Saw SM, Banerjee K, Tan D. Risk factors for the development
of pterygium in Singapore: a hospitalbased case control study.
Acta Ophthalmol Scand. 2000;78:216-220.
© The author/s and Community Eye Health Journal 2018. This is an Open Access
article distributed under the Creative Commons Attribution Non-Commercial License.
OSD indexing_LB1.indd 6
Conjunctival grafting: The thin con- Conjunctival grafting with fibrin glue
junctival graft is placed with correct is a faster procedure and patients
orientation on the area of the con- complain of less pain in the post-op-
junctival defect created by pterygium erative period.
excision. The marker helps to identify Post-operative management:
the correct orientation of the graft. Antibiotic and steroid eye drops
The conjunctival graft can be sutured are given in tapering doses for one
with the 8’0 Vicryl or 10’0 Nylon su- month.
tures or can be glued with fibrin glue.
Conclusion
Many ophthalmologists think that
(c) Sanjay Kumar Singh/ Eastern Regional Eye Care Programme, Nepal
pterygium is a trivial condition for
which not much time should be
expended in surgery and for which
the financial remuneration is low.34
But the patients want a cure, free of
recurrence with good cosmesis after
surgery. Pterygium excision with
conjunctival autograft with fibrin glue
offers a low recurrence rate, good
cosmetic outcome with a reasonable
speed of the pterygium surgery.
Figure 2. A conjunctival auto-
graph marking
13 Ishioka M, Shimmura S, Yagi Y et al. Pterygium and dry eye. 25 Mejia LF, Sanchez JG, Escobar H. Management of primary
Ophthalmologica. 2001:215:209- 211. pterygia using free conjunctival and limbalconjunctival
14 Liu T, Liu Y, Xie L, et al. Progress in the pathogenesis of autografts without antimetabolites. Cornea. 2005;24:972-975.
pterygium. Current Eye Res. 2013;38:1191-1197. 26 Fernandes M, Sangwan VS, Bansal AK et al. Outcome of
15 M.T.Coroneo, N. Di Girolamo and D. Wakeeld. The pterygium surgery: analysis over 14 years. Eye.
pathogenesis of pterygia. Current Opinion in Ophthalmology. 2005;19:1182-1190.
1999;10:282-288. 27 Barraquer JI. Etiology, pathogenesis and treatment of the
16 Matthew H. Ip, Jeanie J Chui, Lien Tat and Minas T. Coroneo. pterygium. Trans New Orleans Acad Ophthalmol.
Significance of Fuchs Flecks in Patients With Pterygium/ 1980;167-178.
Pinguecula: Earliest Indicator of Ultraviolet Light Damage. 28 Solomon A,Pires RT, Tseng SC. Amniotic membrane
Cornea. 2015;34:1560- 1563. transplantation after extensive removal of primary and
17 Lawrence W. Hirst. The Treatment of Pterygium. Survey of recurrent pterygia. Ophthalmology. 2001;108:449-460.
Ophthalmology. 2003;48:2: 145-179. 29 Hirst LW. Prospective study of Primary Pterygium Surgery
18 Lawrence W.Hirst. Prospective Study of Primary Pterygium using Pterygium Extended Removal Followed by Extended
surgery using Pterygium Extended Removal Followed by Conjunctival Transplantation. Ophthalmology.
Extended Conjunctival Transplantation. Ophthalmology. 2008;115:1663-1672.
2008;115:1663- 1672. 30 Hirst LW. Cosmesis after Pterygium extended removal
19 Simsek T, Gunlap I, Atilla H. Comparative efficacy of beta followed by extended conjunctival transplantation as assessed
irradiation and mitomycin-C in primary and recurrent by a new, web-based grading system. Ophthalmology.
pterygium. Eur J Ophthalmol. 2001;11:126-132. 2011;118:1739- 1746.
20 Dougherty PJ, Hardten DR, Lindstrom RL. Corneoscleral melt 31 Hirst LW. Pterygium Extended Removal Followed by Extended
after pterygium surgery using a single intraoperative Conjunctival Transplantation: But on which eye? Cornea.
application of mitomycin-C. Cornea. 1996;15:537-540. 2013;32:799-802.
21 Ma DH, See LC, Liau SB, Tsai RJ. Amniotic Membrane graft for 32 Vanitha Ratnalingam, Andrew Lim Keat Eu, Gem Leong et al.
primary pterygium: comparison with conjunctival autograft Fibrin Adhesive is Better Than Sutures in Pterygium Surgery.
and topical mitomycin C treatment. Br J Ophthalmol. Cornea.2010;29:485-489.
2000;84:973-978. 33 Fan Xu, Min Li, Yumei Yan et al. A Novel Technique of
22 Essex RW, Snibson GR, Daniell M, Tole DM. Amniotic Sutureless and Glueless Conjunctival Autografting in Pterygium
membrane grafting in the surgical management of primary Surgery by Electrocautery Pen. Cornea.2013;32:290-295.
pterygium. Clin. Experiment Ophthalmol. 2004;32:501-504. 34 Essex RW, Snibson GR, Daniell M et al. Amniotic Membrane
23 Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival grafting in the surgical management of primary pterygium.
autograft transplantation for advanced and recurrent Clin Experiment Ophthalmol. 2004;32:501-504.
pterygium. Ophthalmology. 1985;92:1461-1470.
24 Young AL, Leung GY,Wong AK et al. A randomized trial
comparing 0.02% mitomycin-C and limbal conjunctival
autograft after excision of primary pterygium.Br J Ophthalmol.
2004;88:995-997.
COMMUNITY EYE HEALTH JOURNAL | VOLUME 29 | ISSUE 99 | 2017 S6
25/04/2018 18:42