Comparison of Conjunctival Autografts, Amniotic Membrane Grafts, and Primary Closure for Pterygium Excision

TLDR

The study aims to evaluate amniotic membrane grafts as an alternative to conjunctival autografts for pterygium excision. The authors prospectively compared amniotic membrane grafts, primary closure, and conjunctival autografts in 190 eyes, measuring recurrence, survival, and cosmetic outcomes after histopathologic tissue removal. Amniotic membrane grafts had higher recurrence rates (10.9–37.5%) than conjunctival autografts (2.6–9.1%) but lower than primary closure (45%), with delayed recurrence in autografts.

Abstract

Objective: The purpose of the study is to determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. Design: A prospective study of amniotic membrane grafts (group A) and primary closure (group B) was compared retrospectively with conjunctival autografts (group C) in patients with pterygia. Participants: Group A included 46 eyes with primary pterygia and 8 eyes with recurrent pterygia, group B had 20 eyes with primary pterygia, and group C consisted of 78 eyes with primary and 44 eyes with recurrent pterygia. Intervention: For the above three different surgeries, the amount of tissue removed was estimated from histopathologic analysis, and the result was evaluated by clinical examination. Main Outcome Measures: Recurrence, survival analysis, and final appearance were compared. Results: In group A, the recurrence rate was 10.9%, 37.5%, and 14.8% for primary, recurrent, and all pterygia, respectively (mean follow-up, 11 months). These three rates were significantly higher than 2.6%, 9.1 %, and 4.9% noted in group C (mean follow-up, 23 months) (P < 0.001, 0.018, and 0.01, respectively). However, the latter recurrence rate was significantly lower than 45% (mean follow-up, 5.2 months) in group B for primary pterygia (P < 0.001). The onset of recurrence was delayed significantly in group C as compared with that of groups A and B. Conclusions: The relatively low recurrence rate for primary pterygia allows one to use amniotic membrane transplantation as an alternative first choice, especially for advanced cases with bilateral heads or those who might need glaucoma surgery later.