Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia.

OBJECTIVE: To evaluate the postoperative outcome and the recurrence rate after extensive removal of primary and recurrent pterygia combined with amniotic membrane transplantation.
DESIGN: A noncomparative interventional case series. PARTICIPANTS: Fifty-four eyes in 54 subjects with either primary (n = 33) or recurrent (n = 21) pterygia operated on by one surgeon (SCGT). INTERVENTION: All subjects were operated on for pterygia with an extensive excision of the lesion followed by amniotic membrane transplantation and intraoperative injection of a depot corticosteroid. MAIN OUTCOME MEASURES: Cumulative rates of conjunctival (grade 3) and corneal (grade 4) recurrence and incidence of complications.
RESULTS: The mean follow-up was 12.8 +/- 4.3 months for primary and 14.3 +/- 4.9 months for recurrent pterygia. The true recurrence rate (grade 4) was 3.0%, 9.5%, and 5.6% for primary, recurrent, and all pterygia, respectively. The cumulative proportion of recurrence-free eyes at 12 months was 0.90 +/- 0.06 for primary and 0.69 +/- 0.11 for recurrent pterygia (P = 0.047, log-rank test). Removal of the semilunar fold was associated with longer survival times (P = 0.063) and decreased failure rate (P = 0.046). A similar success rate was achieved in double-head pterygia (1 recurrence in 11 eyes).
CONCLUSIONS: Amniotic membrane transplantation is an effective and safe procedure for pterygium surgery, with a relatively low recurrence rate for both primary and recurrent pterygia. It can be a useful alternative to conjunctival autograft when a large conjunctival defect has to be covered, such as in primary double-head pterygia and in large recurrent pterygia.