Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

doi:10.1016/j.ajo.2017.07.004

American Journal of Ophthalmology

Volume 182, October 2017, Pages 8-17

https://doi.org/10.1016/j.ajo.2017.07.004 Get rights and content

Purpose

To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium.

Design

Cochrane systematic review.

Methods

We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis.

Results

Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33–0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21–0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs).

Conclusions

CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.

Section snippets

Methods

Adhering to the methods in the Cochrane Handbook for Systematic Reviews of Interventions, we included only randomized controlled trials (RCTs) in the review.²⁰ Methods are summarized below; details are given in the full Cochrane systematic review.¹⁹ Eligible trials compared CAG with AMT for treatment of pterygium, both primary and recurrent. Trials that permitted ancillary use of MMC or fibrin glue instead of sutures were eligible.

Results

The electronic searches yielded 1841 records, of which we screened 1236 after removing duplicates (Figure 1). We obtained and screened the full-text reports of 35 citations that were potentially relevant. We included 20 RCTs, published in 22 reports, in this review. Our searches of other sources did not identify any other potentially eligible trials. All of the studies were parallel-group RCTs, except 1 that was a within-person RCT. In the latter trial, both eyes of participants had pterygia; 1

Discussion

In this review of 20 randomized controlled trials in which a total of 1947 eyes of 1866 participants were analyzed, we compared the effects of CAG relative to AMT with respect to pterygium recurrence at 3 and 6 months after surgery and found no statistically significant difference in risk of recurrence for primary or recurrent pterygia 3 months after surgery; at 6 months, among 1021 eyes in 10 RCTs, CAG conferred a 47% lower risk of recurrence than did AMT. Although at 6 months after surgery

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Original articleConjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Int J Radiat Oncol Biol Phys

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Saudi J Ophthalmol

Ophthalmology

Ophthalmology

Epidemiology of pterygium. A review

Ophthalmologe

Geographical prevalence and risk factors for pterygium: A systematic review and meta-analysis

BMJ Open

Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome

Cornea

Comparison of amniotic membrane graft alone or combined with intraoperative mitomycin C to prevent recurrence after excision of recurrent pterygia

Cornea

Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon

Br J Ophthalmol

Beta irradiation: new uses for an old treatment: a review

Eye

Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane

Cornea

Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas

Cornea

Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix

J Cell Physiol

Amniotic membrane down-regulates chemokine expression in human keratocytes

Invest Ophthalmol Vis Sci

Original article
Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review