Original articleCosmesis after Pterygium Extended Removal followed by Extended Conjunctival Transplant as Assessed by a New, Web-Based Grading System
Section snippets
Photography
Patients undergoing this procedure are routinely photographed before surgery and most are also photographed at approximately 1, 3, and 12 months after the surgery using a Canon 1DS Mark 1 with a MPE 65-mm Canon macro lens set at 2:1 and a ring flash. None of the images were altered or manipulated in any way.
Cases
All patients in whom a primary nasal pterygium was removed from July 2004 to December 2007 and in whom there was no temporal pterygium, were eligible for inclusion in this study. A photo
Methods
This research was conducted under Human Research Ethics Committee approval and conformed to the tenets of the Declaration of Helsinki.
A trial set of images, and then the complete set of images, were graded by the author according to the grading system described below, on 2 separate occasions and with the author masked to the status of the images (cases or controls). The first grading was undertaken >3 months after the selection of the images and the second grading >1 month after that. The
Results
Over the nominated time period from July 2004 to December 2007, a total of 295 eyes underwent primary nasal pterygium excision; 16 had no photographs or had a follow-up photograph of <3 months postoperatively. However, assessment of the written records of 14 of these demonstrated no recurrences and at least a good or better cosmetic grading at the slit lamp. Two patients did not return for follow-up after the first postoperative day. The postoperative time at which photographs were taken ranged
Discussion
Until now, the principal concern of clinicians and researchers when discussing pterygium surgery has been recurrence rates.1 Few studies have attempted to quantitate cosmetic outcomes.3, 10, 16, 17 Other studies describe the cosmetic results without any formal grading system,2, 4, 9, 19 whereas others only mention cosmesis.5, 6, 7 This study formulates a new, web-based grading system with training modules and uses this system to grade the postoperative results of this new technique.18, 19
This
Acknowledgments
The author thanks Dr Praveen K Nirmalan, Director, PRASHASA Health Consultants Pty Ltd, Hyderabad, India, who provided all statistical assistance, and Mr C. Vikram Kumar, Dot Logic Web Solutions Pty Ltd, Hyderabad, India, who designed the web site.
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Cited by (26)
Snatching: A modified cosmetic technique in pterygium surgery without using scalpel
2023, Journal Francais d'OphtalmologieThe role of cosmesis in pterygium surgery
2022, Journal of Plastic, Reconstructive and Aesthetic Surgery5-Fluorouracil in primary, impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite
2022, Ocular SurfaceCitation Excerpt :Future studies should report whether 5-FU injections had an impact on the rates of patients electing to undergo surgical excision, as this may have cost-benefit implications. It may also be instructive to apply the recently published cosmetic grading systems for pterygia in these studies [93]. This systematic review shows promising results on the use of 5-FU to arrest progression and improve cosmesis of impending recurrent or recurrent pterygia in the postoperative setting and as a sole treatment modality for primary or recurrent pterygia.
Reconstruction of the ocular surface using biomaterial templates
2016, Biomaterials and Regenerative Medicine in Ophthalmology: Second EditionRecurrence and complications after 1000 surgeries using pterygium extended removal followed by extended conjunctival transplant
2012, OphthalmologyCitation Excerpt :It is worth noting that direct conjunctival to conjunctival edge apposition such as this paracaruncular suture line, however carefully it is undertaken, always results in some scarring, and suturing a conjunctival edge to the sclera, such as that at the superior and inferior edge of the graft, can oftentimes leave virtually no perceptible scar. There are a number of other modifications associated with this surgery that are worth highlighting and are principally designed to enhance the final cosmetic appearance that, in a previous study,28 was such that graders could not differentiate normal eyes from eyes that had undergone this procedure, and resulted in almost 95% of eyes having an acceptable cosmetic appearance. These include the large graft that is, at an average square area of 176 mm2, about 7 times the size of an average conjunctival autograft measuring 6×4 mm.
Visual and refractive Outcome After Pterygium Excision by Different Techniques
2022, Egyptian Journal of Ophthalmology, Mansoura Ophthalmic Center
Manuscript no. 2010-1198.
Note. Readers who would like to review the real test with answers highlighted can undertake the test at pterygiumcosmesis.com from November 1, 2010, onward. Researchers who would like to use this web-based cosmesis grading may insert their own images for objective grading assessments by contacting Mr C. Vikram Kumar at [email protected].
Financial Disclosures: The author has made the following disclosure:
The author owns the trademark P.E.R.F.E.C.T. for PTERYGIUM.
Supported in part by the Prevent Blindness Foundation, Brisbane, Australia, which had no role in the design or conduct of the research.