Abstract
Purpose
To assess the effectiveness and safety of the “hydro-fluorescein” adjunct technique for primary pterygium removal.
Design/methods
A non-randomized prospective study was conducted for various types of pterygium excision with superior bulbar conjunctival autograft (CAG) and fibrin glue. We introduced fluorescein staining to ensure thorough elimination of the Tenon tissue around the bare sclera area and the CAG. The primary outcome was the recurrence rate, and the secondary outcome was any complication associated with fluorescein staining.
Results
Ninety-three participants with primary pterygium of Grades 1–3 were recruited and all completed follow-up for at least 1 year. No recurrence was identified during the follow-up period and no long-term adverse reactions were reported with the “hydro-fluorescein” method.
Conclusion
“Hydro-fluorescein” is effective and a safe adjunct in primary pterygium removal and is effective in various grades of pterygia to minimize recurrence with no adverse reaction within 1 year.
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Fig. 1: Preparation of the sterile fluorescence solution.
Fig. 2: Hydro-fluoresceine method.
Fig. 3: The appearance of preoperative and postoperative at 12 months for each sample eye in different groups of pterygia.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
References
Kim KW, Park SH, Kim JC. Fibroblast biology in pterygia. Exp Eye Res. 2016;142:32–9.
ArticlePubMedGoogle Scholar
Detorakis ET, Spandidos DA. Pathogenetic mechanisms and treatment options for ophthalmic pterygium: trends and perspectives (Review). Int J Mol Med. 2009;23:439–47.
ArticlePubMedGoogle Scholar
Chew FLM, Salowi MA, Mustari Z, Husni MA, Hussein E, Adnan TH, et al. Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). PLoS ONE. 2018;13:e0198799-e.
ArticleGoogle Scholar
Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol. 2021;13:25158414211020152.
ArticlePubMedPubMed CentralGoogle Scholar
Amano S, Motoyama Y, Oshika T, Eguchi S, Eguchi K. Comparative study of intraoperative mitomycin C and beta irradiation in pterygium surgery. Br J Ophthalmol. 2000;84:618–21.
ArticlePubMedPubMed CentralGoogle Scholar
Bekibele CO, Baiyeroju AM, Olusanya BA, Ashaye AO, Oluleye TS. Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Eye. 2008;22:31–4.
ArticlePubMedGoogle Scholar
Fonseca EC, Rocha EM, Arruda GV. Comparison among adjuvant treatments for primary pterygium: a network meta-analysis. Br J Ophthalmol. 2018;102:748–56.
ArticlePubMedGoogle Scholar
Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. Ophthalmology 2013;120:201–8.
ArticlePubMedGoogle Scholar
Hirst LW. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. Ophthalmology 2012;119:2205–10.
ArticlePubMedGoogle Scholar
Hirst LW. Prospective study of primary pterygium surgery using pterygium extended removal followed by extended conjunctival transplantation. Ophthalmology 2008;115:1663–72.
ArticlePubMedGoogle Scholar
Hirst LW. Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: recurrence rate and cosmesis. Ophthalmology 2009;116:1278–86.
ArticlePubMedGoogle Scholar
Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol. 1997;115:1235–40.
ArticlePubMedGoogle Scholar
Bilal Khairidzan KMK. Removal of Tenons using hydro-fluorescein technique in pterygium surgery. In: 2019 ASCRS ASOA annual meeting. San Diego, CA: ASCRS; 2019.
Romano V, Cruciani M, Conti L, Fontana L. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. Cochrane Database Syst Rev. 2016;12:Cd011308.
PubMedGoogle Scholar
Lan A, Xiao F, Wang Y, Luo Z, Cao Q. Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence. Oncotarget 2017;8:41487–97.
ArticlePubMedPubMed CentralGoogle Scholar
Yan B, Peng L, Peng H, Zhou S, Chen B. Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a randomized controlled trial. Cornea 2019;38:1351–7.
ArticlePubMedGoogle Scholar
Hirst LW, Sebban A, Chant D. Pterygium recurrence time. Ophthalmology 1994;101:755–8.
ArticlePubMedGoogle Scholar
Chu WK, Choi HL, Bhat AK, Jhanji V. Pterygium: new insights. Eye. 2020;34:1047–50.
ArticlePubMedPubMed CentralGoogle Scholar
Mohd Radzi H, Khairidzan MK, Mohd Zulfaezal CA, Azrin EA. Corneo-pterygium total area measurements utilising image analysis method. J Optom. 2019;12:272–7.
ArticlePubMedPubMed CentralGoogle Scholar
O'Goshi K, Serup J. Safety of sodium fluorescein for in vivo study of skin. Ski Res Technol. 2006;12:155–61.
ArticleGoogle Scholar
Nagaya T, Nakamura YA, Choyke PL, Kobayashi H. Fluorescence-guided surgery. Front Oncol. 2017;7:314.
ArticlePubMedPubMed CentralGoogle Scholar
Takamura E, Tsubota K, Watanabe H, Ohashi Y. Diquafosol Ophthalmic Solution Phase 3 Study G. A randomised, double-masked comparison study of diquafosol versus sodium hyaluronate ophthalmic solutions in dry eye patients. Br J Ophthalmol. 2012;96:1310–5.
ArticlePubMedGoogle Scholar
Tey KY, Teo K, Tan ACS, Devarajan K, Tan B, Tan J, et al. Optical coherence tomography angiography in diabetic retinopathy: a review of current applications. Eye Vis. 2019;6:37.
ArticleGoogle Scholar
Fuest M, Mehta, JS, Coroneo, MT. New treatment options for pterygium. Expert Rev. Ophthalmol. 2017;12:193–196.
Lee JS, Ha SW, Yu S, Lee GJ, Park YJ. Efficacy and safety of a large conjunctival autograft for recurrent pterygium. Korean J Ophthalmol. 2017;31:469–78.
ArticlePubMedPubMed CentralGoogle Scholar
Janson BJ, Sikder S. Surgical management of pterygium. Ocul Surf. 2014;12:112–9.
ArticlePubMedGoogle Scholar
Bradley JC. Management of recurrent pterygium. Thorofare, NJ: Slack; 2012.
Kim KW, Kim JC. Current approaches and future directions in the management of pterygium. Int J Ophthalmol. 2018;11:709–11.
PubMedPubMed CentralGoogle Scholar
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;43:405–19.
ArticlePubMedGoogle Scholar
Buratto L, Phillips R, Carito G. Clinical picture and classification. In: Drummond AE, editor. Pterygium Surgery. USA: SLACK; 2000. pp. 11–13.
Starck T, Kenyon KR, Serrano F. Conjunctival autograft for primary and recurrent pterygia: surgical technique and problem management. Cornea 1991;10:196–202.
ArticlePubMedGoogle Scholar
Chen R, Huang G, Liu S, Ma W, Yin X, Zhou S. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol. 2017;255:375–85.
ArticlePubMedGoogle Scholar
Kumar D, Agarwal A. Pterygium: postoperative management and complications. Pterygium: techniques and technologies for surgical success. Thorofare, NJ: Slack Incorporated; 2012. pp. 111–120.
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Authors and Affiliations
Department of Ophthalmology, Universiti Malaysia Sarawak, Sarawak, Malaysia
Mohd-Asyraaf Abdul-Kadir
Department of Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
Mohd-Asyraaf Abdul-Kadir & Khairidzan Mohd Kamal
Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
Mohd Radzi Hilmi
Authors
Mohd-Asyraaf Abdul-Kadir
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2. Mohd Radzi Hilmi
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3. Khairidzan Mohd Kamal
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Contributions
MA prepared the manuscript, figures, and tables. MH and KK designed and supervised the study. All authors revised the final manuscript before submission.
Corresponding author
Correspondence to Khairidzan Mohd Kamal.
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The authors declare no competing interests.
Ethical approval
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Research Ethics Committee of the International Islamic University Malaysia (IIUM/310/G13/4/-125).
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Informed consent was obtained from all individual participants included in the study.
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Supplementary information
Table 1, Table 2, Table 3, Table 4.
Hydrofluorescein pterygium excision
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Abdul-Kadir, MA., Hilmi, M.R. & Mohd Kamal, K. Safety and efficacy of “hydro-fluorescein” technique in removing Tenon in pterygium surgery: a 1-year follow-up study. Eye (2024). https://doi.org/10.1038/s41433-024-03539-7
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Received:11 August 2023
Revised:30 May 2024
Accepted:29 November 2024
Published:10 December 2024
DOI:https://doi.org/10.1038/s41433-024-03539-7
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