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Pterygium refers to abnormal overgrowth of conjunctival fibrovascular tissue. It tends to grow into the cornea, impairing visual acuity by inducing astigmatism, and in severe cases, it may encroach the pupil and directly occlude the optical axis [1]. The etiology and pathogenesis of pterygium are not fully elucidated. The factors known to induce the condition include exposure to UV light, dust and dirt, as well as dry eye syndrome, and old age [1, 2]. The primary mode of management is surgery. There are many techniques to remove pterygium surgically, ranging from simple excision leaving the sclera exposed to removal followed by filling the defect with a conjunctival autograft or amniotic membrane with the use of sutures or tissue glue [3-6]. There are multiple variants of these procedures, such as P.E.R.F.E.C.T. (pterygium extended removal followed by extended conjunctival transplantation) or CLAG (conjunctival limbal autograft). In the scientific literature, there is no consensus as to which of the techniques of surgical pterygium removal is the best because some of the procedures are still associated with a high risk of recurrence. Based on the available reports, the risk of recurrence after using the technique ABSTRACT Aims of the study were to assess the corneal parameters, visual acuity, and risk of recurrence after pterygium removal procedures involving amniotic membrane attachment to the scleral bed with freeze-dried fibrin glue and – on that basis – to evaluate the safety and therapeutic efficacy of the method. Material and methods: The study involved a total of 27 patients. The inclusion criteria were the diagnosis of primary pterygium, absence of other ophthalmic disorders, and no history of eye injuries or ophthalmic surgery. The patients’ corneal parameters (including pachymetry, corneal endothelial cell density) and visual acuity on days 7, 30 and 60 after the surgery were compared with corresponding baseline values in order to evaluate changes. Results: Stable or improved visual acuity was demonstrated in all the subjects, with 26 patients achieving a BCVA of 1.0. The corneal endothelial cell population remained at a steady level in all the subjects, and none experienced a decline in cell density. Pachymetry showed a slight variability during the period of follow-up, with an initial upward trend up until day 30 after the surgery ultimately followed by a return closer to the baseline value on day 60 postoperatively. None of the study participants reported any pain. Two recurrences of pterygium were noted during the follow-up period of 60 days. Conclusions: The findings of the study show that the applied technique of pterygium removal with amniotic membrane transplantation using fibrin glue is associated with a low recurrence rate (7.4%), absence of postoperative pain, stability or improvement of visual acuity, a consistent level of corneal endothelial cell population, and stable pachymetry values. Based on these outcomes, the method appears to be an effective and safe technique of pterygium removal. However, in view of the small size of the study group and the short postoperative follow-up period, further studies are needed to obtain more definite results.

klinika oczna

Surgical removal of pterygium using amniotic membrane transplant mounted on freeze-dried fibrin glue – assessment of post-operative visual acuity, corneal endothelial cells density, pachymetry and recurrence