A study shows 3 strategies to treat primary pterygium are safe and effective, with 2 surgical techniques using no autograft or limited autograft causing fewer traumas and offering more flexibility for changes to the condition compared with conjunctival autograft. The results were published in the American Journal of Ophthalmology.

The study, a prospective randomized controlled clinical trial, compared the efficacy and safety in the treatment of primary pterygium using conjunctival autograft (CAG), amniotic membrane transplantation (AMT) with postoperative interferon alpha-2b (IFN alpha-2b), and modified conjunctival autograft plus amniotic membrane transplantation (mCAG+AMT) with postoperative IFN alpha-2b. A total of 85 patients with eyes that had nasal and primary pterygia were randomized in a 1:1:1 ratio to have 1 of the techniques included in the study (30 in CAG group, 25 in AMT group, 30 in CAG+AMT group). Follow-up lasted for 12 months. The primary outcomes in the study included recurrence rate and complications; secondary outcomes included corneal epithelium status, ocular surface symptom score and visual acuity change.

The investigators found no complications or grade 4 recurrence. Additionally,  no significant differences were seen in the 3 groups for recurrence grade, corneal epithelium status, or visual acuity change.


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“Compared with mCAG+AMT, CAG has a negative effect (B=-0.62, P =.001), and AMT has a negative effect (B=-2.02 P <.001) on postoperative symptom scores,” they reported. “Compared with AMT, CAG has a positive effect (B=1.28, P <.001) on postoperative symptom scores.”

“All 3 surgical procedures that were performed in this study demonstrated safety and clinical efficacy,” the study concludes. “IFN alpha-2b eye drops effectively reduced the recurrence rate of pterygium in patients after AMT or mCAG plus AMT. Compared to CAG, which is the current gold standard for treating pterygium, the 2 other surgeries, which do not use autograft or use only small autograft, provide a more flexible approach for managing ocular surface abnormalities in future.”

The study’s limitations include its small sample design and the fact it was performed at a single center. In addition, while 90% of pterygium recurrence happens in the first year (making the one-year follow-up design of this study adequate), longer follow-up is still needed.

Reference

Yu J, Feng J, Jin T, et al. The effect of a novel strategy in treating primary pterygium: a prospective randomized clinical study. Am J Ophthalmol. Published online January 4, 2021. doi:10.1016/j.ajo.2021.01.001