Surgical Result of Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation (P.E.R.F.A.M.T) Wei-Li Chen, MD, PhD Associate.

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Presentation transcript:

Surgical Result of Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation (P.E.R.F.A.M.T) Wei-Li Chen, MD, PhD Associate Professor, National Taiwan University Hospital Director, Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital

Financial Disclosure The authors have no commercial proprietary interest in the products or companies mentioned here

Prevention of Recurrence after Pterygium Surgery Adjunctive procedures: Mitomycin C application, β irradiation, amniotic membrane transplantation, conjunctival transplantation Other surgical factors: the EXTENT of Tenon's layer removal underneath conjunctival edge

Extended Removal of Tenon's Layer

P.E.R.F.A.M.T Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation

P.E.R.F.A.M.T Surgical Procedure Peribulbar anesthesia Remove pterygium Tenon's layer was extensively removed to superior and inferior recti and back to the caruncle Bare sclera: 14×14 mm with medial rectus remained Mitomycin C (0.2mg/ml) for 2 minutes Amniotic membrane transplantation with fibrin glue 3 ×10-0 nylon sutures to anchored AM and limbus 2 × 8-0 vicryl sutures to anchor conjunctival edge and the edge of the AM at 3 mm away from the limbus

Observational Parameters

Grading Systems for Recurrence and Cosmetic Results

Grading of Postoperative Wound Edge and Caruncular Morphology (A) Normal wound edge at temporal canthus (Grade 1) (B) Grade 1 : Nasal (C) Grade 2 : Nasal (D) Grade 3 : Nasal (E) Grade 4 : Nasal (F) Grade 5 : Nasal

Additional Complications (A) Granulom pyogenica in a grade 4 caruncle; (B) subamniotic membrane hemorrhage; (C) fat prolapse at the caruncle ; (D) synechia of the caruncluar area with limitation of ocular motility limitation

Biographic Data 57 patients undergoing P.E.R.F.A.M.T. in 58 eyes. 40 primary/18 recurrent pterygium All patients received follow-up for at least 12 months.

Results Post-Operative Recurrence Grade 1: 47 (47/58=81%) Grade 2: 0 Grade 3: 7 (7/58=13.8%) Grade 4 (true corneal recurrence): 4 (4/58=6.9%)

Nasal Conjunctival Edge and Caruncular Morphology Grade 1: 32/54=59.3% Grade 2: 8/54=14.7% Grade 3: 5/54=9.3% Grade 4: 9/54=16.7% Grade 5: 1/54=1.9%

Additional Complications Granuloma Pyogenica: 3/58 (5.1%) Transient diplopia: 2/58 (3.3%) Permanent motility restriction: 2/58 (3.3%) Steroid induced glaucoma: 2/58 (3.3%) Fat prolapse: 1/58 (1.7%) Submembrane hematoma: 1/58 (1.7%) Calcium deposition: 2/58 (3.3%)

Conclusions P.E.R.F.A.M.T. results in low recurrence rate, satisfactory cosmetic results of conjunctival wound edge/caruncle, and low additional complications P.E.R.F.A.M.T. is easy to performed, and can save operative time P.E.R.F.A.M.T. can avoid the significant conjunctival damage compared to conjunctival transplantation (P.E.R.F.E.C.T)

The End