RESUMEN
OBJECTIVE: To perform a 12 month follow-up study to assess the safety and effectiveness of resection and conjunctival autograft fixed with Tissucol® in selected cases of large pterygium. The orientation of the graft was adapted to the morphology of the scleral bed for a better coverage free of traction, with limbal position being lost. METHODS: A prospective, non-comparative study of 10 cases of grade II or superior pterygium (7 primary, 3 recurrent) with at least 8mm of limbal extension. A wide scleral bed was obtained after pterygium and Tenon resection, with larger grafts being required to cover the defects. A superior conjunctival autograft was harvested and fixed to bare sclera using Tissucol. The orientation was adapted to the morphology of the scleral bed and limbal position was lost. Patients were periodically assessed for recurrence and complications for a period of 12 months. RESULTS: Minor complications occurred in 4 eyes. In one case a buttonhole was formed during dissection of the graft. Two presented with small limbal dehiscence, but epithelialisation was completed in the first week. In a third case, it was necessary to increase topical corticosteroids for pyogenic granuloma on the donor site, with secondary increased intraocular pressure (IOP). There were no recurrences after 12 months follow-up. CONCLUSIONS: A conjunctival graft of appropriate size adapted to the morphology of the scleral bed to ensure good coverage free of tension, provides good surgical results in selected cases of pterygium, regardless of the conservation the limbal orientation, with no recurrences after one year follow-up.
Asunto(s)
Conjuntiva/trasplante , Pterigion/cirugía , Esclerótica/cirugía , Anciano , Femenino , Adhesivo de Tejido de Fibrina , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/métodos , Estudios Prospectivos , Pterigion/patología , Rotación , Trasplante Autólogo/métodos , Resultado del TratamientoRESUMEN
Objetivo: Evaluar la ocurrencia de recidivas y otras complicaciones con el uso de Mitomicina C intraoperatoria en la cirugía de pterigio. Diseño del estudio y métodos: Se diseñó un estudio de retrospectivo, comparando la aplicación de Mitomicina C 0,1% intraoperatoria con la realización de injerto en la cirugía de pterigion en la clínica Medyser de Bucaramanga, Colombia. Se estudiaron un total de 305 ojos operados en este centro entre el primero de marzo de 2014 y el 29 de febrero de 2016, distribuidos en dos grupos, 126 ojos en el grupo de expuestos y 179 ojos en el grupo de no expuestos. Resultados: Se encontró que existe un factor protector del uso de Mitomicina C aplicada intraoperatoriamente para disminuir la incidencia de complicaciones como el dellen corneal, presencia de recidivas, leucoma residual, sobreinfección, hemorragia subconjuntival, haze corneal y rasgado por la sutura, con mayor riesgo de presentar granulomas y reabsorción del injerto. Conclusiones: De acuerdo a esto, la utilización de la Mitomicina C se presenta como una alternativa muy segura y eficaz en el manejo quirúrgico del pterigion, usada al 0,1% por 30 segundos, como se propone; sin embargo, se hace necesario diseñar un ensayo clínico comparativo con el gold standard actual como es la realización del injerto libre con células limbares.
Objective: To evaluate the pterygium recurrence and complications by the use of Mitomycin C during surgery. Study Design and Methods: We designed a retrospective study, comparing the application of Mitomycin C 0,1% intraoperative with the use of a graft in pterygium surgery at the Medyser Clinic in Bucaramanga Colombia, we studied 305 eyes operated at this center between the fi rst March 2014 and 29 February 2016 and were distributed into two groups: 126 eyes in the exposed group and 179 eyes in the non-exposed group. Results: We found there is a protective factor in the use of Mitomycin C applied intraoperatively to decrease the incidence of complications as the corneal dellen, pterygium recurrence, residual leucoma, infection added, conjunctival hemorrhage, haze corneal and graft rupture by suture, with greater risk of granulomas presence and graft resorption. Conclusions: Accordingly, the use of Mitomycin C appears as a very safe and effective alternative, using a 0,1% by 30 seconds, as e proposed, in the surgical management of pterygium; however, it is necessary to design a comparative clinical trial with the today's gold standard as it is the realization of free graft with limbal cells surgery.