Recurrence of the pterygium after excision: What factors do relate it? Hong Kyun Kim Dept. of Ophthalmology Kyungpook National University School of medicine

Purpose To evaluate the factors that influence the recurrence of the pterygium after excision Patients and Methods 37 eyes of patients including 14 males and 23 females pterygium in the age range of 22 – 66 years (mean age 52.4 years ± 12.1) There were 20 eyes of primary pterygium and 17 recurrent pterygium. Each eyes underwent a complete ocular examination and were taken photograph to evaluate the molphologic severity of pterygium

Patients and Methods – Exclusion Criteria patients with pseudopterygium patients with severe dry eye syndrome, meibomian gland dysfunction, neurotrophic keratitis. if the patients did not follow up at least 6months Patients and Methods - Preoperaitve morphologic severity grading by Slit lamp Photography Evaluate the thickness, vascularity, the amount of encroachment on cornea of the fibrovascular proliferation - Thickness (T) - Vascularity (V) - Location(L)

Grade of Thickness (T) T0 : no elevation T1 : minimal elevation with definite confirmation of episcleral vessel in most of the elevated area. T2 : moderate elevation, episcleral vessel can be found in some of the elevated area. T3 : marked elevation, episcleral vessel cannot be found because of the pterygial fleshiness.

Grade of Vascularity (V) We use the computer program (Adobe Photoshop ver.9.0) to compare the vascularity of each pterygial proliferation equalized and inverted photo from original photo original photograph

Grade of Vascularity (V) V0 : no directional vascular pattern V1 : minimal vascularization with unidirectional patterm V2 : moderate vascularization with unidirectional and enlarged vessels V3 : marked vascularization with unidirectional, engorged vessels V0 V2 V1 V3

Location (L) L1 : abnormal fibrovascular tissue were confined conjunctival area L2 : abnormal fibrovascular tissue were located in limbal area. L3 : abnormal fibrovascular tissue were encroached over limbal area. (> 1.0 mm from limbus)

Surgical Technique Pterygial Excision Method Subconjunctival 2% lidocaine Mark the incision line with the gentian violet The head of Pterygium was avulsed with a 0.3mm toothed forceps Wescott scissors was used to dissect the underlying conjunctiva and Tenon’s capsule and excised the Tenon. with or without 0.04% MMC sub Tenon’s soaking for 2min. excise additional exposed Tenon’s capsule Covering methods over pterygium excised area Conjunctival Autograft Conjuntival Autograft + Amniotic membrane graft Amniotic membrane graft

Patient F/U include who completely followed up over 6months Definition of Recurrence “a certain amount of fibrous reproliferation with unidirectional vascularity after excisional operation” - Recurrence that need the Re-operation 1. Recurrence over the > 1mm past the limbus (L3) with T3 or V3 2. fibrovascular proliferation over L2 with adhesive traction that results in diplopia - Conjuntival Recurrence Recurrence within L2 and do not cause the diplopia

Evaluation of Risk factor for Recurrence Univariate Analysis (Chi-squre test, SPSS for Windows ver.12.0, P<0.05) comparison of the incidence of the recurrence in following variables Preoperative morphologic feature 1. primary / recurrence 2. preoperative fibrous thickness (T2 /T3) 3. preoprative vascularity 4. symblepharous fibrous traction Operation technique 1. amniotic membrane 2. conjunctive autograft Adjunctive Treatment 1. preopeative TA subconjunctival injection 2. preoperative MMC injection 3. intraoperative 0.04% MMC soaking Multivariate analysis (Logistic Regression Analysis, SPSS for Windows ver. 12.0, p<0.05))

Results follow-up period - mean 8.4 ±4.6 (6-18 months) Recurrence rate - total recurrence rate 14/37 eyes (37.8%) - conjunctival recurrence rate 10/37 (27.0%) - Recurrence that need the Re-operation 4/37 (10.8% There were no statistic significance in preoperative mophologic variables and Adjunctive treatment Conjunctival Autograft was the only statistically significant variable. - Fisher’s exact test, p=0.015; OR 7.08; 95% CI Multiple logistic regression analysis, p=0.028; OR 5.42; 95% CI )

Conclusion preoperative morphologic factors or adjunctive treatment did not affect the recurrence of the pterygium conjunctival autograft was significantly decreased the risk of the reccurence of the pterygium