Role of Post-Operative Topical Corticosteroids in Recur rence Rate after Pterygium Excision with Conjunctival Autograft

SUDARAT YAISAWANG, MD*, PITT A Y A PlY APATTANAKORN, MD*

Affiliation : * Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.

AbstractBackground : Recurrence of pterygium is the most common failure of the pterygium opera tion. The use of conjunctival autograft after pterygium excision has shown a low recurrence rate. However, it has a board range of variations regarding the recurrence rates, which may be influenced by many factors. From the authors' clinical observation, it was found that the recurrence rate was higher in patients who received inadequate post-operative topical corticosteroid treatment.
Objective : To study the association between adequacy of post-operative topical cortico steroids and recurrence rate in patients with primary pterygium who underwent excision with conjunc tival autograft.
Design : Retrospective, case-control study.
Subjects and
Method : A total of 142 eyes of 137 patients with primary pterygium who underwent excision with conjunctival autograft between January 1996 and June 2002 were enrolled in this study. These patients were evaluated for recurrence of their pterygia and adequacy of post-opera tive topical corticosteroids by chart review, re-examination, self-reported questionnaire, and interview. Cases were patients with recurrent pterygium. Controls were from patients without recurrence.
Results :There were 21 recurrences (14.8%) of a total of 142 eyes treated. Five of the 21 recurrences occurred in good compliant patients with adequate post-operative topical corticosteroid therapy. Sixteen recurrences occurred in patients with inadequate post-operative topical corticosteroids. In this group, 6 cases missed their follow-up schedules, 3 cases were lost to follow-up after 1.5-2 months, 1 case had poor compliance with treatment, and 6 cases were steroid responders then the treat ment was discontinued or changed to a weaker preparation. The study demonstrates significant asso ciation between the adequacy of post-operative topical corticosteroid and pterygium recurrence rate. The odds ratio was 190.4 (95% CI, 36.61-951.84).
Conclusions : A high recurrence rate was found in patients who received inadequate post operative topical corticosteroid. However, the recurrence rate was much lower from 14.8 per cent to 4 per cent when the patients with inadequate corticosteroid therapy were excluded. The study provides evidence that post-operative topical corticosteroids appear to play a role in reducing the pterygium recurrence rate.

Keywords : Pterygium, Conjunctival Autograft, Topical Corticosteroids

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