Genç erkeklerde konjonktival otogreftli pterjium cerrahisi ve indüklenmiş astigmatizma

Amaç: Genç yaşta konjonktival otogreftli pterjiyum cerrahisi yapılan erkek olguların sonuçlarının değerlendirilmesi ve indüklenen astigmatizmanın hesaplanması. Gereç ve yöntem: Primer pterjiyum tanılı 20 olgunun 22 gözüne konjonktival otogreftli pterjiyum cerrahisi uygulandı. Pterjiumun görmede şikayet oluşturması, pupil hizasına yaklaşmış olması ve kozmetik sebeplerle kişilerin ameliyat istemeleri halinde ameliyata karar verildi. Herhangi bir oküler cerrahi geçirmiş hastalar, oküler yüzey hastalığı, göz kapak problemi olanlar ve sistemik hastalığı olanlar çalışmaya dahil edilmedi. Ameliyat öncesi, ameliyat sonrası 1.ay ve en son kontrollerinde tam bir oftalmolojik bakı yapıldı. İndüklenmiş astigmatizma refraktif parametreler kullanılarak Vektöryel Analiz Programı’ndan yararlanılarak hesaplandı. Bulgular: Yirmi olgunun 22 gözü çalışmaya dahil edildi. Yaş ortalaması 22.50 ± 4.15 (20-39) yıl idi. Çalışmaya dahil edilen 20 olgunun hepsi erkek hastalardan oluşmuştur. Yirmi iki gözün 14’ü sağ, 8’i sol gözdür. Görme keskinliği ve göz içi basıncı değerlerinin ameliyat öncesi ve sonrası tüm değerlendirmelerinde istatistiksel olarak anlamlılık saptanmamıştır.(p=0.142,p=0.831) Ameliyat sonrasında 4 gözde nüks (%18), 2 gözde konjonktival granülom (%9) görülmüştür. Ameliyat sonrası ortalama 1.aydaki indüklenmiş astigmatizmalarının aritmetik ortalaması 0.91±1.19 D olarak bulunmuş, gözlerin yaklaşık % 60’ında kurala aykırı astigmatizma saptanmıştır. Olgular ameliyat sonrası ortalama 93.59±36.47 gün takip edilmiştir. Sonuç: Genç yaştaki primer pterjiumlu olgularda, konjonktival otogreftli cerrahinin nüks ve komplikasyonlarının az olması ayrıca görme keskinliği üzerine olumsuz etkisinin bulunmaması nedeniyle tercih edilebilir yöntem olduğu düşünülmüştür.

Pterygium surgery with conjunctival autograft and induced astigmatism in young men

Objectives: To evaluate the results obtained from male subjects who underwent pterygium surgery with conjunctival autograft and to calculate the induced astigmatism. Materials and methods: Pterygium surgery with conjunctival autograft was performed on 22 eyes of 20 subjects diagnosed with primary pterygium. If pterygium caused a vision problem or approached the pupil level, and if surgery was requested from the individuals for cosmetic reasons, the decision to operate was made. Patients who underwent any ocular surgery, have ocular surface disease, eyelid problems or systemic disease were not included in the study. A complete ophthalmologic examination was performed before surgery, at one month following the surgery, and during the final controls. Induced astigmatism was calculated by using refractive parameters and Vectorial Analysis Program. Results: Twenty-two eyes of 20 subjects were included in the study. Mean age was 22.50 ± 4.15 (20-39) years. All subjects included in the study were male patients. Of the 22 eyes, 14 were right and 8 were left eyes. In the evaluations of visual acuity and intraocular pressure values preand post- surgery, no statistical significance was detected (p=0.142, p=0.831). During the surgery, relapse was detected in 4 eyes (18%) and conjunctival granuloma (9%) was detected in 2 eyes. Following the surgery, arithmetic average of the induced astigmatisms at 1st month was 0.91±1.19 D; against-the-rule astigmatism was detected in nearly 60% of the eyes. The subjects were followed up for 93.59±36.47 days after the surgery. Conclusions: In primary pterygium subjects of young age, surgery with conjunctival autograft was considered as a preferable method due to its low number of relapse and complications, as well as absence of any adverse effect on visual acuity.

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1. Nakaishi H, Yamamoto M, Ishida M, Someya I, Yamada Y. Pingueculae and pterygia in motorcycle policemen. Ind Health 1997;35(3):325-9.
2. Jaros PA, DeLouise VP. Pingueculae and pterygia. Surv Ophthalmol 1988; 33(1): 41- 9.
3. Oldenburg JB, Garbus J, Mc Donnel JM. McDonnel P. Conjunctival pterygia: mechanism of corneal topographic changes. Cornea 1990; 9(3):200-4.
4. Tamer C, Oksuz H, Tomac S. [Topical mitomycin c aided pterygium surgery without excission] Turkiye Klinikleri J Ophthalmol 2007, 16(3):145-9.
5. Egrilmez S, Dalkilic G, Yagci A. [Vector analysis software on analyzing astigmatism] Turkish J Ophthalmology 2003; 3(1): 404-15.
6. Adamis AP, Starck T, Kenyon KR. The management of ptergium Ophthalmol. Cli North Am 1990;3(4):611-23.
7. Kenyon KR, Wagoner MD, Hettinger ME.: Conjunctival autogreft transplantation for advanced and recurrent pterygium. Ophthalmol 1985;92(11):1461-70.
8. Riordan-Eva P, Kielhorn I, Ficker LA, Steele AD, Kirkness CM. Conjunctival autografting in the surgical management of pterygium. Eye 1993; 7(5):634-8.
9. Chen PP, Ariyasu RG, Kaza V, LaBree LD, McDonnell PJ. A randomized trial comparing mitomycin C and cojunctival autograft after excision of primary pterygium. Am J Ophthalmol 1995; 120(2):151-60.
10. Prabhasawat P, Barton K, Burkett G, Tseng SC. Comparison of conjunctival autografts, amniotic membrane grafts and primary closure for pterygium excision. Ophthalmology 1997; 104(6):974-85.
11. Yasar T, Ozdemir M, Baranbari I, Demirok A.[ Comparison of conjunctival autografting with bare sclera and mitomycin C application of pterygium surgery.] MN Ophthalmology 2002; 9(3):298-300.
12. Atmaca P, Bekir NA, Bulbul M. [Comparison of different surgical techniques of pterygium management.] Turkiye Klinikleri J Ophthalmol 2002; 11(4):212-8.
13. Koranyi G, Seregard S, Kopp ED. The cut-and-paste method for primary pterygium surgery: long-term follow-up. Acta Ophthalmol Scand 2005; 83(3):298-01.
14. Ma DHK, See LC, Liau SB, Tsai RJF. Amniotic membrane graft for primary pterygium:comparison with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol 2000; 84(9): 973-78.
15. Ti SE, Chee SP, Dear KBG, Tan DT. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol 2000; 84(4): 385-9.
16. Fernandes M, Sangwan VS, Bansal AK, et al. Outcome of pterygium surgery: analysis over 14 years. Eye (Lond) 2005;19(11):1182-90.
17. Gonen T, Cosar B, Keskinbora K, Acar S.[ Impact of Pterygium Surgery on Corneal Topography] Turkiye Klinikleri J Med Sci 2010;30(3):1055-60.
18. Oh JY, Wee WR. The effect of pterygium surgery on contrast sensitivity and corneal topographic changes. Clin Ophthalmol 2010;26(4):315-9.
19. Wu PL, Kuo CN, Hsu HL, Lai CH. Effect of pterygium surgery on refractive spherocylinder power and corneal topography. Ophthalmic Surg Lasers Imaging 2009;40(1):32-7.
20. Maheshwari S. Effect of pterygium excision on pterygium induced astigmatism. Indian J Ophthalmol 2003;51(2):187-8.
21. Dadeya S, Malik KP, Gullian BP.: Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft. Ophthalmic Surg Lasers 2002;33(4):269-74.