https://doi.org/10.31288/oftalmolzh20156612

Clinical efficacy of pterygium surgery technique involving use of high frequency welding of biological tissues for fixing free limbal conjunctival autograft

V.Ia. Usov, Dr. Sc. (Med) E.V. Maltsev, Dr. Sc. (Med), Prof. N.I. Krytsun, Postgraduate Student

Filatov Eye Disease and Tissue Therapy Institute, the NAMS of Ukraine

Odessa (Ukraine)

E-mail: Natalya1979@ukr.net

Background: It is important to reduce the rate of early complications following pterygium surgery.

Purpose: To determine whether the use of high-frequency welding of biological tissues (HFWBS) for fixing a free limbal conjunctival autograft (LCAG) improves the efficacy of surgical treatment of pterygium.

Material and Methods: We retrospectively analyzed data from 73 patients (73 eyes) who underwent free LCAG surgery for different stages of pterygium. Patients were divided into the HFWBS group (34 patients; 34 eyes) and the control group (39 patients; 39 eyes). The former underwent pterygium surgery involving the use of HFWBS for fixing a free LCAG with upgraded EK-300M1 apparatus and special bipolar forceps, and the latter underwent free LCAG with sutures following pterygium excision. Efficacy was assessed in terms of clinical signs (corneal reepithelialization rate, inflammatory response intensity, corneal syndrome intensity, and corneal transparency at the site of excised pterygium) postoperatively.

Results: At day 5, (a) complete corneal re-epithelialization was significantly more often found in the HFWBS group (30/34 eyes; 88.2%) than in controls (20/39 eyes; 51.3%) (?2 = 13.7; р = 0.00021), (b) patients of the former group had neither the highest nor a high score of local inflammatory vascular response, whereas 3/39 (7.6%) patients of the latter group had the highest score of local inflammatory vascular response (?2 = 237; р = 0.00003), and (c) signs of corneal syndrome were found in 1/34 eyes (2.9%) of the HFWBS group vs 39/39 eyes (100%) of controls; i.e., corneal syndrome was observed 97.1% less often in the HFWBS group than in controls. At observation time points less than 3 months, restoration of corneal transparency was observed in 33/34 eyes (97.1%) of the HFWBS group vs 12/39 eyes (30.8%) of controls (р = 0.0001).

Conclusion: First, in LCAG, the use of HFWBS significantly improves the efficacy of surgical treatment of pterygium. At day 3, complete corneal re-epithelialization was significantly more often found in the HFWBS group than in controls (73.5% vs 15.4%; difference, 58.1%). At day 5, this difference remained statistically significant and was 36.9%. Second, at all observation time points, low vascular response scores were found statistically significantly more often in the HFWBS group than in the controls (Pu < 0.015). Third, LCAG with HFWBS was found advantageous over LCAG with sutures in terms of corneal syndrome, since, at day 5, practically all eyes (33/34 eyes; 97.1%) of the HFWBS group were quiet, whereas all eyes (39/39 eyes; 100%) of the controls were mildly irritated (?2 = 69.1; р = 0.00001). Finally, at month 3, restoration of corneal transparency was observed in the HFWBS group 66.3% more often than in controls (?2 = 33.8; р = 0.00001), thus supporting the advantage of HFWBS in pterygium treatment with LCAG.

Key words: pterygium, sutures, electric welding, autograft

References

1. Borodin IuI, Val’skii VV, Verigo EN. [Late outcomes of combination treatment of recurrent pterygium]. Oftalmologiia. 2007;3(4):29-33. Russian

2. Veselovs’ka ZF et al. [Microsurgical technique for treatment of pterygium]. In: [Proceedings of the 2nd Congress of Black Sea Ophthalmological Society]. Odessa: Filatov Institute of Eye Disease and Tissue Therapy; September 8-10, 2004. p.18-9. Ukrainian

3. Iakimenko SA. [Surgical treatment for persistent recurrent pterygium]. Zdravokhr Turkmen. 1983;11:41-2. Russian 

4. Gris O, Guell JL, del Campo Z. Limbal-conjunctival autograft transplantation for the treatment of recurrent pterygium. Ophthalmology. 2000 Feb;107(2):270-3.
Crossref

5. Isyaku M. Treatment of pterygium. Annals African Medicine. 2011;10(3):197-203
Crossref

6. Ye J, Kook KH, Yao K. Temporary amniotic membrane patch for the treatment of primary pterygium: mechanisms of reducing the recurrence rate. Graefes Arch Clin Exp Ophthalmol. 2006 May;244(5):583-8.
Crossref

7. Maltsev EV, Usov VIa, Krytsun NI. [Current techniques for treatment of pterygium]. Oftalmol Zh. 2012;3:72-80. Ukrainian

8. Bakbardina LM, Bakbardina II. [Peripheral barrier keratoplasty with biologically protected tissue bed in treatment of recurrent pterygium]. Oftalmol Zh. 2004;5:83-5. Russian

9. de Wit D, Athanasiadis I, Sharma A, Moore J. Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series. Eye (Lond). 2010 Sep;24(9):1474-7.
Crossref

10. Umanets NN. [High-frequency welding of biological tissues (upgraded generator EK-300M1) versus diathermocoagulation: influence on duration of hemorrhage from major retinal vessels in a rabbit model of intraocular hemorrhage]. Oftalmol Zh. 2012;4:88-91. Russian
Crossref

11. Maltsev EV, Usov VIa, Krytsun NI. [Determination of optimal electric current parameters in use of highfrequency welding of biological tissues for sealing the edges of surgical wound of conjunctiva]. Oftalmol Zh. 2013;3:78-82. Ukrainian
Crossref

12. Dudinov SA. [Pterygium Classification: Methodology Guide]. Moscow; 1973. p25-7. Russian 

13. Usov VIa, Maltsev EV, Krytsun NI. [Pterygium surgery technique involving use of high frequency welding of biological tissues for fixing free limbal conjunctival autograft]. Oftalmol Zh. 2015;2:10-5. Ukrainian