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Evaluation of the Effect of Cryotherapy in Limbal Conjunctival Autograft Technique in Pterygium Surgery

Yıl 2021, Cilt: 5 Sayı: 2, 126 - 131, 30.08.2021
https://doi.org/10.30565/medalanya.864068

Öz

Aim: To compare the complication and recurrence rates in patients undergoing limbal conjunctival autograft with or without adjuvant cryotherapy for primary or recurrent pterygia.

Methods: All information about the cases operated between January 2014 and January 2019 was scanned from the electronic database. Fifty-three eyes undergoing limbal conjunctival autograft combined with cryotherapy were classified as Group 1, and 47 eyes undergoing only limbal conjunctival autograft were classified as Group 2. Any development of new fibrovascular tissue from the limbus to the cornea after surgery was considered a recurrence. Any complications occurring during and after surgery were noted.

Results: In Group 1, 45 of the 53 patients had primary and eight had recurrent pterygia. In Group 2, 41 of the 47 patients had primary and six had recurrent pterygia. Both groups were similar in terms of age and gender (p=0.880 and p=0.835, respectively). The mean follow-up period was 27.0±8.6 months in Group 1 and 28.7±7.8 months in Group 2 (p=0.287). No recurrences were observed during the follow-up period in Group 1, while the recurrence rate in Group 2 was 10.6% (p=0.02). All relapses occurred within the first year. No complications were observed during surgery in either group. Graft oedema was observed in the early post-operative period in four patients in Group 1 and three patients in Group 2.

Conclusion: Limbal conjunctival graft technique combined with cryotherapy is a successful and reliable method in the treatment of primary and recurrent pterygium.

Kaynakça

  • 1. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: clinical perspectives. Clin Ophthalmol. 2018;12:2347-62. doi: 10.2147/OPTH.S186543.
  • 2. Syam PP, Eleftheriadis H, Liu CS. Inferior conjunctival autograft for primary pterygia. Ophthalmology. 2003;110(4):806-10. doi: 10.1016/S0161-6420(02)01970-X.
  • 3. Kılıç R, Karacan Erşekerci T, Göktolga G, Üstün Çomçalı S, Ağadayı A. Results of Limbal Conjunctival Autograft Transplantation in Primary and Recurrent Pterygium Surgery / Turk J Ophthalmol 2014;44:449-53. doi: 10.4274/tjo.59489.
  • 4. Mutlu FM, Sobacı G, Tatar T, Yildirim E. A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology. 1999;106(4):817-21. doi: 10.1016/S0161-6420(99)90172-0.
  • 5. Hovanesian JA, Starr CE, Vroman DT, Mah FS, Gomes JAP, Farid M, et al. Surgical techniques and adjuvants for the management of primary and recurrent pterygia. J Cataract Refract Surg. 2017;43(3):405-19. doi: 10.1016/j.jcrs.2017.03.002.
  • 6. Fraunfelder FW. Cryotheraphy for pterygia. Ophthalmology. 2008;115(12):2314-2314.e2. doi: 10.1016/j.ophtha.2008.06.027.
  • 7. Meneghim RLFS, Satto LH, Natsuaki KL, Oliveira AC, Padovani CR, Viveiros MMH, et al. Topical cyclosporine A 0.05% before and after surgery to prevent pterygium recurrence. Arq Bras Oftalmol. 2019;82(5):372-6. doi: 10.5935/0004-2749.20190075.
  • 8. Manzur P. The role of intracellular freezing in the death of cells cooled at supraoptimal rates. Cryobiology. 1977;14(3):251-72. doi: 10.1016/0011-2240(77)90175-4.
  • 9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37(3):171-86. doi: 10.1006/cryo.1998.2115.
  • 10. Luyer BJ, Schinio PM. Life and death at low temperatures. Biodynamica. 1940;3:369.
  • 11. Smith JJ, Fraser J. An estimation of tissue damage and thermal history in the cryolesion. Cryobiology. 1974;11(2):139-47. doi: 10.1016/0011-2240(74)90303-4.
  • 12. Bietti GB. Ricerche sulle variazioni di temperature di alcune zone del bulbo oculaire per diatermocoagulaxioni episclerali, termocauterizazioni e criocausticazioni. Boll Ocul. 1933;12:1427–57.
  • 13. Veckeneer M, Van Overdam K, Bouwens D, Feron E, Mertens D, Peperkamp E, et al. Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery. Am J Ophthalmol. 2001;132(3):343-7. doi: 10.1016/s0002-9394(01)01026-1.
  • 14. Dobson V, Quinn GE, Summers CG, Robert J Hardy, Betty Tung, Cryotherapy for Retinopathy of Prematurity Cooperative Group. Visual acuity at 10 years in cryotherapy for retinopathy of prematurity study eyes: effect of retinal residua of retinopathy of prematurity. Arch Ophthalmol. 2006;124(2):199-202. doi: 10.1001/archopht.124.2.199.
  • 15. Gallie BL, Budning A, DeBoer G, Thiessen JJ, Koren G, Verjee Z, et al. Chemotherapy with focal therapy can cure intraocular retinoblastoma without radiotherapy. Arch Ophthalmol. 1996;114(11):1321-8. doi: 10.1001/archopht.1996.01100140521001.
  • 16. Goldenberg-Cohen N, Bahar I, Ostashinski M, Moshe Lusky, Dov Weinberger, Dan D Gaton. Cyclocryotherapy versus transscleral diode laser cyclophotocoagulation for uncontrolled intraocular pressure. Ophthalmic Surg Lasers Imaging. 2005;36(4):272-9. PMID: 16156142
  • 17. Fraunfelder FT, Wallace TR, Farris HE, Watkins 3rd J, Hendrickson R, Smead WJ, et al. The role of cryosurgery in external ocular and periocular disease. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977;83(4 Pt 1):713-24. PMID: 898492
  • 18. Fraunfelder FW. Lıquıd nıtrogen cryotherapy for surface eye dısease (an AOS thesıs). Trans Am Ophthalmol Soc. 2008;106:301-24. PMID: 19277243
  • 19. Eroğul LE. New Mediators and Growth Factors Affecting Pterium Growth Acta Medica Alanya 2017:2;99-102. doi: 10.30565/medalanya.294045
  • 20. Alsmman AH, Radwan G, Abozaid MA, Mohammed UA, Elhaleim NGA. Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results. Clin Ophthalmol. 2017;11:493-501. doi: 10.2147/OPTH.S127700.
  • 21. Jakobiec FA, Rini FJ, Fraunfelder FT, Brownstein S. Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma: experience with 62 cases. Ophthalmology. 1988;95(8):1058-70. doi: 10.1016/s0161-6420(88)33058-7.
  • 22. Peksayar G, Soytürk MK, Demiryont M. Long-term results of cryotherapy on malignant epithelial tumors of the conjunctiva. Am J Ophthalmol. 1989;107(4):337-40. doi: 10.1016/0002-9394(89)90655-7.
  • 23. Moesen I, Duncan M, Cates C, Taylor A, Wintle RV, Ismail A, et al. Nitrous oxide cryotheraphy for primary periocular basal cell carsinoma: outcome at 5 years follow-up. Br J Ophthalmol. 2011;95(12):1679-81. doi: 10.1136/bjo.2009.173021.
  • 24. Dushku N, John MK, Schultz GS, Reid TW. Pterygia pathogenesis: corneal invasion by matrix metalloproteinase expressing altered limbal epithelial basal cells. Arch Ophthalmol. 2001;119(5):695-706. doi: 10.1001/archopht.119.5.695.
  • 25. Ozer A, Yıldırım N, Erol N, Yurdakul S. Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions. Ophthalmologica. 2009;223(4):269-73. doi: 10.1159/000210444.

Pterjium Cerrahisinde Limbal Konjonktival Otogreft Tekniğinde Kriyoterapinin Etkinliğinin Değerlendirilmesi

Yıl 2021, Cilt: 5 Sayı: 2, 126 - 131, 30.08.2021
https://doi.org/10.30565/medalanya.864068

Öz

Amaç: Primer veya tekrarlayan pterjiumda adjuvan kriyoterapi ile birlikte veya tek başına limbal konjonktival otogreft uygulanan hastalarda komplikasyon ve nüks oranlarını karşılaştırmak.

Yöntem: Ocak 2014 ile Ocak 2019 tarihleri arasında ameliyat edilen vakalarla ilgili tüm bilgiler elektronik veri tabanından tarandı. Kriyoterapi ile kombine olarak limbal konjonktival otogreft uygulanan 53 göz Grup 1, sadece limbal konjonktival otogreft uygulanan 47 göz Grup 2 olarak sınıflandırıldı. Ameliyattan sonra limbustan korneaya herhangi bir yeni fibrovasküler doku gelişimi nüks olarak kabul edildi. Ameliyat sırasında ve sonrasında ortaya çıkan herhangi bir komplikasyon not edildi.

Bulgular: Grup 1'de 53 hastanın 45'inde primer ve sekizinde tekrarlayan pterjium vardı. Grup 2'de 47 hastanın 41'inde primer ve altısında tekrarlayan pterjium vardı. Her iki grup yaş ve cinsiyet açısından benzerdi (p=0.880 ve p=0.835; sırasıyla). Ortalama takip süresi Grup 1'de 27.0±8.6 ay, Grup 2'de 28.7±7.8 aydı (p=0.287). Grup 1'de takip döneminde nüks görülmezken, Grup 2'de nüks oranı % 10,6 idi. (p=0.02). Tüm nüksler ilk yıl içinde gerçekleşti. Her iki grupta da ameliyat sırasında herhangi bir komplikasyon görülmedi. Grup 1'de 4, Grup 2'de 3 hastada erken postoperatif dönemde greft ödemi görüldü.

Sonuç: Kriyoterapi ile kombine edilerek yapılan limbal konjonktival greft tekniği primer ve rekürren pterjium tedavisinde başarılı ve güvenilir bir yöntemdir.

Kaynakça

  • 1. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: clinical perspectives. Clin Ophthalmol. 2018;12:2347-62. doi: 10.2147/OPTH.S186543.
  • 2. Syam PP, Eleftheriadis H, Liu CS. Inferior conjunctival autograft for primary pterygia. Ophthalmology. 2003;110(4):806-10. doi: 10.1016/S0161-6420(02)01970-X.
  • 3. Kılıç R, Karacan Erşekerci T, Göktolga G, Üstün Çomçalı S, Ağadayı A. Results of Limbal Conjunctival Autograft Transplantation in Primary and Recurrent Pterygium Surgery / Turk J Ophthalmol 2014;44:449-53. doi: 10.4274/tjo.59489.
  • 4. Mutlu FM, Sobacı G, Tatar T, Yildirim E. A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology. 1999;106(4):817-21. doi: 10.1016/S0161-6420(99)90172-0.
  • 5. Hovanesian JA, Starr CE, Vroman DT, Mah FS, Gomes JAP, Farid M, et al. Surgical techniques and adjuvants for the management of primary and recurrent pterygia. J Cataract Refract Surg. 2017;43(3):405-19. doi: 10.1016/j.jcrs.2017.03.002.
  • 6. Fraunfelder FW. Cryotheraphy for pterygia. Ophthalmology. 2008;115(12):2314-2314.e2. doi: 10.1016/j.ophtha.2008.06.027.
  • 7. Meneghim RLFS, Satto LH, Natsuaki KL, Oliveira AC, Padovani CR, Viveiros MMH, et al. Topical cyclosporine A 0.05% before and after surgery to prevent pterygium recurrence. Arq Bras Oftalmol. 2019;82(5):372-6. doi: 10.5935/0004-2749.20190075.
  • 8. Manzur P. The role of intracellular freezing in the death of cells cooled at supraoptimal rates. Cryobiology. 1977;14(3):251-72. doi: 10.1016/0011-2240(77)90175-4.
  • 9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37(3):171-86. doi: 10.1006/cryo.1998.2115.
  • 10. Luyer BJ, Schinio PM. Life and death at low temperatures. Biodynamica. 1940;3:369.
  • 11. Smith JJ, Fraser J. An estimation of tissue damage and thermal history in the cryolesion. Cryobiology. 1974;11(2):139-47. doi: 10.1016/0011-2240(74)90303-4.
  • 12. Bietti GB. Ricerche sulle variazioni di temperature di alcune zone del bulbo oculaire per diatermocoagulaxioni episclerali, termocauterizazioni e criocausticazioni. Boll Ocul. 1933;12:1427–57.
  • 13. Veckeneer M, Van Overdam K, Bouwens D, Feron E, Mertens D, Peperkamp E, et al. Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery. Am J Ophthalmol. 2001;132(3):343-7. doi: 10.1016/s0002-9394(01)01026-1.
  • 14. Dobson V, Quinn GE, Summers CG, Robert J Hardy, Betty Tung, Cryotherapy for Retinopathy of Prematurity Cooperative Group. Visual acuity at 10 years in cryotherapy for retinopathy of prematurity study eyes: effect of retinal residua of retinopathy of prematurity. Arch Ophthalmol. 2006;124(2):199-202. doi: 10.1001/archopht.124.2.199.
  • 15. Gallie BL, Budning A, DeBoer G, Thiessen JJ, Koren G, Verjee Z, et al. Chemotherapy with focal therapy can cure intraocular retinoblastoma without radiotherapy. Arch Ophthalmol. 1996;114(11):1321-8. doi: 10.1001/archopht.1996.01100140521001.
  • 16. Goldenberg-Cohen N, Bahar I, Ostashinski M, Moshe Lusky, Dov Weinberger, Dan D Gaton. Cyclocryotherapy versus transscleral diode laser cyclophotocoagulation for uncontrolled intraocular pressure. Ophthalmic Surg Lasers Imaging. 2005;36(4):272-9. PMID: 16156142
  • 17. Fraunfelder FT, Wallace TR, Farris HE, Watkins 3rd J, Hendrickson R, Smead WJ, et al. The role of cryosurgery in external ocular and periocular disease. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977;83(4 Pt 1):713-24. PMID: 898492
  • 18. Fraunfelder FW. Lıquıd nıtrogen cryotherapy for surface eye dısease (an AOS thesıs). Trans Am Ophthalmol Soc. 2008;106:301-24. PMID: 19277243
  • 19. Eroğul LE. New Mediators and Growth Factors Affecting Pterium Growth Acta Medica Alanya 2017:2;99-102. doi: 10.30565/medalanya.294045
  • 20. Alsmman AH, Radwan G, Abozaid MA, Mohammed UA, Elhaleim NGA. Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results. Clin Ophthalmol. 2017;11:493-501. doi: 10.2147/OPTH.S127700.
  • 21. Jakobiec FA, Rini FJ, Fraunfelder FT, Brownstein S. Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma: experience with 62 cases. Ophthalmology. 1988;95(8):1058-70. doi: 10.1016/s0161-6420(88)33058-7.
  • 22. Peksayar G, Soytürk MK, Demiryont M. Long-term results of cryotherapy on malignant epithelial tumors of the conjunctiva. Am J Ophthalmol. 1989;107(4):337-40. doi: 10.1016/0002-9394(89)90655-7.
  • 23. Moesen I, Duncan M, Cates C, Taylor A, Wintle RV, Ismail A, et al. Nitrous oxide cryotheraphy for primary periocular basal cell carsinoma: outcome at 5 years follow-up. Br J Ophthalmol. 2011;95(12):1679-81. doi: 10.1136/bjo.2009.173021.
  • 24. Dushku N, John MK, Schultz GS, Reid TW. Pterygia pathogenesis: corneal invasion by matrix metalloproteinase expressing altered limbal epithelial basal cells. Arch Ophthalmol. 2001;119(5):695-706. doi: 10.1001/archopht.119.5.695.
  • 25. Ozer A, Yıldırım N, Erol N, Yurdakul S. Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions. Ophthalmologica. 2009;223(4):269-73. doi: 10.1159/000210444.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Umut Dağ Bu kişi benim 0000-0002-7866-7898

Mehtap Çağlayan 0000-0003-4878-824X

Süleyman Vardar Bu kişi benim 0000-0003-0172-4177

Fuat Alakuş 0000-0002-1588-7869

Hasan Öncül 0000-0003-0513-6065

Yusuf Yıldırım Bu kişi benim 0000-0002-1067-4653

Yayımlanma Tarihi 30 Ağustos 2021
Gönderilme Tarihi 19 Ocak 2021
Kabul Tarihi 17 Şubat 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 5 Sayı: 2

Kaynak Göster

Vancouver Dağ U, Çağlayan M, Vardar S, Alakuş F, Öncül H, Yıldırım Y. Evaluation of the Effect of Cryotherapy in Limbal Conjunctival Autograft Technique in Pterygium Surgery. Acta Med. Alanya. 2021;5(2):126-31.

9705 

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