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Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft

Received: 19 November 2019     Accepted: 16 December 2019     Published: 24 December 2019
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Abstract

Purpose - This study aims at analyzing the visual and refractive outcomes following simultaneous phacoemulsification and pterygium excision with conjunctival autograft (CAG). Setting-Tertiary eye care hospital in South India. Design-Retrospective study. Methods-508 eyes that underwent simultaneous phacoemulsification with pterygium excision between 2011-2017 were included in the study. Exclusion criteria-Pre-operative astigmatism of > 2 D, grade 3 pterygia, recurrent or double head pterygia, traumatic or complicated cataract. Pre-operative evaluation-clinical examination, keratometry, IOL power calculation, retinoscopy and subjective refraction. Procedure-Phacoemulsification with foldable monofocal IOL followed by pterygium excision with conjunctival autografting using tissue glue. Post-operative follow up-Periodically up to 6 months. Results- Mean pre-operative best corrected visual acuity (LogMAR) was 0.41+/-0.46 with post-operative mean being 0.04+/-0.12 (p=0.001). Mean pre-operative and post operative astigmatism were -1.25+/-0.60 D and -0.73+/-0.58 D (p=0.001) respectively. Mean post-operative myopic spherical error was -0.85+/-0.48 D. 34.33% of the patients had a post-operative refractive error out of which 87.42% had myopia and 12.57% had a hypermetropic error (<1D). 63.27% of the eyes with myopic error had an error of < 1 D. Most commonly seen complication was sub conjunctival haemorrhage followed by graft retraction in 12 and 10 eyes respectively. Conclusion- The combined single step procedure of phacoemulsification with pterygium excision in indicated cases, is safe and effective with good visual outcomes. The post-operative myopic residual error can be anticipated and reduced by slightly under correcting the IOL power in patients with concurrent pterygium to optimize the visual outcome.

Published in International Journal of Ophthalmology & Visual Science (Volume 4, Issue 4)
DOI 10.11648/j.ijovs.20190404.19
Page(s) 106-110
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Phacoemulsification, Pterygium, Conjunctival Autograft

References
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[2] Kwok LS, Coroneo MT et al. A model for pterygium formation. Cornea 1994; 13: 219-24.
[3] Cameron ME et al: Pterygium throughout the world. Springfield, Charles C Thomas, 1965, pp 141-171.
[4] Hiller R, Giacometti L, Yuen K et al (1977) Sunlight and cataract: an epidemiologic investigation. Am J Epidemiol 105 (5): 450–459.
[5] Hollows F, Moran D et al (1981) Cataract—The ultraviolet risk factor. Lancet 2 (8258): 1249–1250.
[6] Huchbaum DR, Moskowitz SE, Wirtschafter JD et al: A quantitative analysis of astigmatism induced by pterygium. J Biomech 10: 735746, 1977.
[7] Lim R, Mitchell P, Cumming RG et al. Cataract associations with pinguecula and pterygium: the Blue Mountains Eye Study. Am J Ophthalmol. 1998; 126: 717–719.
[8] Ibechukwu BI et al. Simultaneous pterygium and intraocular surgery. Br J Ophthalmol. 1990; 74: 265–266.
[9] Gulani A, Dastur YK et al. Simultaneous pterygium and cataract surgery. J Postgrad Med. 1995; 41: 8–11.
[10] Kodavoor SK, Ramamurthy D, Tiwari NN, Ramamurthy S et al. Double-head pterygium excision with modified vertically split-conjunctival autograft: Six-year long-term retrospective analysis. Indian J Ophthalmol 2017; 65: 700-4.
[11] Kamiya, Kazutaka MD, PhD; Shimizu, Kimiya MD, PhD et al. Predictability of Intraocular Lens Power Calculation After Simultaneous Pterygium Excision and Cataract Surgery. Medicine, December 2015 - Volume 94 - Issue 52 - p e2232.
[12] Cinal A, Yasar T, Demirok A, et al. The effect of pterygium surgery on corneal topography. Ophthalmic Surg Lasers. 2001; 32: 35–40.
[13] Yasar T, Ozdemir M, Cinal A, et al. Effects of fibrovascular traction and pooling of tears on corneal topographic changes induced by pterygium. Eye (Lond). 2003; 17: 492–496.
[14] Errais K, Bouden J, Mili-Boussen I, et al. Effect of pterygium surgery on corneal topography. Eur J Ophthalmol. 2008; 18: 177–181.
[15] Wu PL, Kuo CN, Hsu HL, et al. Effect of pterygium surgery on refractive spherocylinder power and corneal topography. Ophthalmic Surg Lasers Imaging. 2009; 40: 32–37.
[16] Nejima R, Masuda A, Minami K, et al. Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration. Eye Contact Lens. 2015; 41: 58–63.
[17] Kim SW, Park S, Im CY, et al. Prediction of mean corneal power change after pterygium excision. Cornea. 2014; 33: 148–153.
[18] Tomidokoro A, Miyata K, Sakaguchi Y, et al. Effects of pterygium on corneal spherical power and astigmatism. Ophthalmology. 2000; 107: 1568–1571.
[19] Koc M, Uzel MM et al, Pterygium size and effect on intraocular lens power calculation. J Cataract Refract Surg. 2016 Nov; 42 (11): 1620-1625.
[20] Gumus, Koray & I. Tung, Cynthia & Al-Mohtaseb, Zaina et al (2017). Management of Pterygium with Coexisting Cataract. 10.5005/jp/books/13069_21.
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    Shreesha Kumar Kodavoor, Soundarya B, Ramamurthy Dandapani. (2019). Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft. International Journal of Ophthalmology & Visual Science, 4(4), 106-110. https://doi.org/10.11648/j.ijovs.20190404.19

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    ACS Style

    Shreesha Kumar Kodavoor; Soundarya B; Ramamurthy Dandapani. Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft. Int. J. Ophthalmol. Vis. Sci. 2019, 4(4), 106-110. doi: 10.11648/j.ijovs.20190404.19

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    AMA Style

    Shreesha Kumar Kodavoor, Soundarya B, Ramamurthy Dandapani. Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft. Int J Ophthalmol Vis Sci. 2019;4(4):106-110. doi: 10.11648/j.ijovs.20190404.19

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  • @article{10.11648/j.ijovs.20190404.19,
      author = {Shreesha Kumar Kodavoor and Soundarya B and Ramamurthy Dandapani},
      title = {Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {4},
      number = {4},
      pages = {106-110},
      doi = {10.11648/j.ijovs.20190404.19},
      url = {https://doi.org/10.11648/j.ijovs.20190404.19},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20190404.19},
      abstract = {Purpose - This study aims at analyzing the visual and refractive outcomes following simultaneous phacoemulsification and pterygium excision with conjunctival autograft (CAG). Setting-Tertiary eye care hospital in South India. Design-Retrospective study. Methods-508 eyes that underwent simultaneous phacoemulsification with pterygium excision between 2011-2017 were included in the study. Exclusion criteria-Pre-operative astigmatism of > 2 D, grade 3 pterygia, recurrent or double head pterygia, traumatic or complicated cataract. Pre-operative evaluation-clinical examination, keratometry, IOL power calculation, retinoscopy and subjective refraction. Procedure-Phacoemulsification with foldable monofocal IOL followed by pterygium excision with conjunctival autografting using tissue glue. Post-operative follow up-Periodically up to 6 months. Results- Mean pre-operative best corrected visual acuity (LogMAR) was 0.41+/-0.46 with post-operative mean being 0.04+/-0.12 (p=0.001). Mean pre-operative and post operative astigmatism were -1.25+/-0.60 D and -0.73+/-0.58 D (p=0.001) respectively. Mean post-operative myopic spherical error was -0.85+/-0.48 D. 34.33% of the patients had a post-operative refractive error out of which 87.42% had myopia and 12.57% had a hypermetropic error (<1D). 63.27% of the eyes with myopic error had an error of < 1 D. Most commonly seen complication was sub conjunctival haemorrhage followed by graft retraction in 12 and 10 eyes respectively. Conclusion- The combined single step procedure of phacoemulsification with pterygium excision in indicated cases, is safe and effective with good visual outcomes. The post-operative myopic residual error can be anticipated and reduced by slightly under correcting the IOL power in patients with concurrent pterygium to optimize the visual outcome.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Visual and Refractive Outcomes Following Simultaneous Phacoemulsification and Pterygium Excision with Conjunctival Autograft
    AU  - Shreesha Kumar Kodavoor
    AU  - Soundarya B
    AU  - Ramamurthy Dandapani
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    DO  - 10.11648/j.ijovs.20190404.19
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 106
    EP  - 110
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20190404.19
    AB  - Purpose - This study aims at analyzing the visual and refractive outcomes following simultaneous phacoemulsification and pterygium excision with conjunctival autograft (CAG). Setting-Tertiary eye care hospital in South India. Design-Retrospective study. Methods-508 eyes that underwent simultaneous phacoemulsification with pterygium excision between 2011-2017 were included in the study. Exclusion criteria-Pre-operative astigmatism of > 2 D, grade 3 pterygia, recurrent or double head pterygia, traumatic or complicated cataract. Pre-operative evaluation-clinical examination, keratometry, IOL power calculation, retinoscopy and subjective refraction. Procedure-Phacoemulsification with foldable monofocal IOL followed by pterygium excision with conjunctival autografting using tissue glue. Post-operative follow up-Periodically up to 6 months. Results- Mean pre-operative best corrected visual acuity (LogMAR) was 0.41+/-0.46 with post-operative mean being 0.04+/-0.12 (p=0.001). Mean pre-operative and post operative astigmatism were -1.25+/-0.60 D and -0.73+/-0.58 D (p=0.001) respectively. Mean post-operative myopic spherical error was -0.85+/-0.48 D. 34.33% of the patients had a post-operative refractive error out of which 87.42% had myopia and 12.57% had a hypermetropic error (<1D). 63.27% of the eyes with myopic error had an error of < 1 D. Most commonly seen complication was sub conjunctival haemorrhage followed by graft retraction in 12 and 10 eyes respectively. Conclusion- The combined single step procedure of phacoemulsification with pterygium excision in indicated cases, is safe and effective with good visual outcomes. The post-operative myopic residual error can be anticipated and reduced by slightly under correcting the IOL power in patients with concurrent pterygium to optimize the visual outcome.
    VL  - 4
    IS  - 4
    ER  - 

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Author Information
  • Cornea Services, the Eye foundation, Coimbatore, India

  • Cornea Services, the Eye foundation, Coimbatore, India

  • Cataract and Refractive Services, the Eye Foundation, Coimbatore, India

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