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Klin Monbl Augenheilkd 2023; 240(10): 1214-1220
DOI: 10.1055/a-2048-6608
Klinische Studie

A New Approach: Determination of the Safe Surgical Margin in Pterygium Surgery

Ein neuer Ansatz: Bestimmung des sicheren chirurgischen Randes in der Pterygium-Chirurgie
Yasar Dag
1   Ophthalmology, Basaksehir Çam ve Sakura Sehir Hastanesi, Istanbul, Turkey
,
Ayse Armutlu
2   Pathology, Koç Üniversitesi Hastanesi, Istanbul, Turkey
,
Yakup Acet 
3   Eye Disease, Mardin Training and Research Hospital, Mardin, Turkey
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Abstract

Purpose In this retrospective study, we aimed to determine the safe surgical limit for excision of pterygium tissue. Therefore, we aimed to prevent excessive or incomplete normal conjunctival tissue excision during surgery in the coming years.

Methods Autografted pterygium surgery was performed between January 2015 and April 2016, and the excised pterygium tissue was examined histopathologically. The files of 44 patients, who had not previously undergone any ocular surgery, who did not have an inflammatory disease and who continued to be checked for at least 1 year, were retrospectively examined. The distance (P-DSEM) from the excised pterygium tissue to the surgical excision margin was measured by a pathologist. Postoperative recurrence rates were evaluated according to this value. In this way, the clean surgical margin was determined.

Results The mean age of the participants was 44.77 ± 12.70, and the mean follow-up time was 55.61 ± 16.38 months. Recurrence developed in 5 out of 44 patients (11.4%). The average recurrence duration was 51 ± 13.87 days. Distance to the average surgical margin was 3.88 ± 0.91 mm. The surgical distances of 5 patients with recurrence were 2, 2.5, 2, 3, and 3 mm, respectively. It was determined that recurrence was less as the distance (P-DSEM) from the tissue to the surgical excision margin increased (p = 0.001).

Conclusions We found that the recurrence rate in pterygium surgery was linked to the clean surgical margin. When planning pterygium surgery, we believe that determining the amount of tissue to be excised before surgery will reduce recurrence rates.

Zusammenfassung

Zweck In dieser retrospektiven Studie wollten wir die sichere chirurgische Grenze für die Exzision von Pterygiumgewebe feststellen. Wir wollten die übermäßige oder unvollständige Entfernung von normalem Bindehautgewebe während der Operation in Zukunft verhindern.

Methoden Autotransplantierte Pterygiumoperationen wurden zwischen Januar 2015 und April 2016 durchgeführt und das herausgeschnittene Pterygiumgewebe histopathologisch untersucht. Die Akten von 44 Patienten, die zuvor keiner Augenoperation unterzogen wurden, die keine entzündliche Erkrankung hatten und die mindestens 1 Jahr nachbeobachtet wurden, wurden rückwirkend untersucht. Der Abstand (P-DSEM) vom herausgeschnittenen Pterygiumgewebe bis zum chirurgischen Exzisionsrand wurde von einem Pathologen gemessen. Postoperative Rezidivraten wurden entsprechend zu diesem Wert ausgewertet. Auf diese Weise wurde der saubere Operationsrand bestimmt.

Ergebnisse Das Durchschnittsalter der Teilnehmer betrug 44,77 ± 12,70 Jahre und die mittlere Nachbeobachtungszeit betrug 55,61 ± 16,38 Monate. 5 von 44 Patienten (11,4%) entwickelten ein Rezidiv. Die durchschnittliche Rezidivdauer betrug 51 ± 13,87 Tage. Der durchschnittliche chirurgische Exzisionsrand betrug 3,88 ± 0,91 mm. Der Exzisionsrand bei 5 Patienten mit Rezidiv betrug 2, 2,5, 2, 3 und 3 mm. Es wurde festgestellt, dass Rezidive seltener auftraten, wenn der Abstand (P-DSEM) vom Gewebe zum Exzisionsrand größer war (p = 0,001).

Schlussfolgerungen Wir fanden heraus, dass die Rezidivrate bei Pterygiumoperation mit dem sauberen Operationsrand verbunden war. Wir glauben, dass bei der Planung von Pterygium-Operationen, die Bestimmung der Menge an Gewebe, die vor der Operation entfernt werden muss, Rezidive reduzieren wird.

Conclusions

Already known

  • The most common complication in pterygium surgery is recurrence. Primary excision and autograft are the most commonly used surgical techniques to reduce recurrence. The amount of conjunctival excision to be made is still not standardized.

Newly described

  • In this study, for the first time in pterygium surgery, what should be the safe surgical margin was examined. We found that there was less recurrence in surgery in which we excised wide and placed a wide autograft and we showed this histopathologically. As the histopathologically clear surgical margin widened, the recurrence rate was lower. In future prospective studies, it should be histopathologically standardized how many mm of normal conjunctival tissue should be removed together with the pterygium tissue. Thus, a safe surgical margin will be created with intraoperative frozen sections.

Key words

pterygium surgical distance - pterygium surgery - relapsed pterygium - pterygium - cornea

Schlüsselwörter

Bindehaut - Kornea - plastische Chirurgie - sicherer chirurgischer Rand - Pterygium


Publication History

Received: 15 October 2022

Accepted: 22 February 2023

Article published online:
30 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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