Comparison of conjunctival autograft transplantation and amniotic membrane transplantation for pterygium: a meta-analysis

Cornea

Abstract

Background

Conjunctival autograft transplantation (CAT) and amniotic membrane transplantation (AMT) are two widely used techniques for pterygium treatment. However, previous studies comparing the outcomes of CAT and AMT have generally had small sample sizes and conflicting results. The aim of this report was to evaluate and comment on peer-reviewed literature for evidence of effectiveness and safety of CAT and AMT for management of pterygium.

Methods

Studies comparing outcomes of CAT and AMT for pterygium treatment were identified by searching PubMed, Embase, Web of Knowledge, and a search of all references in relevant papers. Two reviewers confirmed study eligibility and extracted data independently, and data were pooled using standard meta-analysis techniques.

Results

Five eligible studies reporting outcomes in 538 eyes were included. The pooled hazard ratio (HR) estimate for recurrence of CAT compared to AMT was 0.30 (95% confidence interval (CI) [0.16, 0.59], p < 0.001) and 0.22 (95%CI [0.02, 2.37], p = 0.214), respectively, for primary and recurrent pterygium. For unacceptable appearance, the pooled HR estimate was 0.33 (95% CI [0.16, 0.66], p = 0.002). There were no statistically significant differences in adverse events (odds ratio (OR) = 0.96, 95% CI [0.46, 1.97], p = 0.901).

Conclusions

Available trials indicate that CAT has lower recurrence risk compared to AMT for primary pterygium treatment, as well as lower risk of unacceptable appearance risk.

Keywords

Pterygium Amniotic membrane Conjunctival autograft Transplantation 

Notes

Funding

None.

Competing interest

None to declare.

Declaration

The authors have full control of all primary data and agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review our data upon request.

References

  1. 1.
    Ang LP, Tan DT (2005) Autologous cultivated conjunctival transplantation for recurrent viral papillomata. Am J Ophthalmol 140:136–138PubMedCrossRefGoogle Scholar
  2. 2.
    Hirst LW (2003) The treatment of pterygium. Surv Ophthalmol 48:145–180PubMedCrossRefGoogle Scholar
  3. 3.
    Todani A, Melki SA (2009) Pterygium: current concepts in pathogenesis and treatment. Int Ophthalmol Clin 49:21–30PubMedCrossRefGoogle Scholar
  4. 4.
    Kim JC, Tseng SC (1995) Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 14:473–484PubMedCrossRefGoogle Scholar
  5. 5.
    Hao YX, Ma D, Hwang DG, Kim WS, Zhang F (2000) Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea 19:348–352PubMedCrossRefGoogle Scholar
  6. 6.
    Tseng SC, Li DQ, Ma X (1999) Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J Cell Physiol 179:325–335PubMedCrossRefGoogle Scholar
  7. 7.
    Bultmann S, You L, Spandau U, Rohrschneider K, Volcker HE, Kruse FE (1999) Amniotic membrane down-regulates chemokine expression in human keratocytes. Invest Ophthalmol Vis Sci 40:3044Google Scholar
  8. 8.
    Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834PubMedCrossRefGoogle Scholar
  9. 9.
    Deeks JJ, Altman DG (2001) Effect measures for meta-analysis of trials with binary outcomes. In: Egger M, Davey Smith G, Altman DG (eds) Systematic reviews in health care; meta-analysis in context. 2nd ed. London: BMJ Books, pp 313–335Google Scholar
  10. 10.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  11. 11.
    Prabhasawat P, Barton K, Burkett G, Tseng SC (1997) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 104:974–985PubMedGoogle Scholar
  12. 12.
    Ma DH, See LC, Liau SB, Tsai RJ (2000) Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol 84:973–978PubMedCrossRefGoogle Scholar
  13. 13.
    Tananuvat N, Martin T (2004) The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft. Cornea 23:458–463PubMedCrossRefGoogle Scholar
  14. 14.
    Kucukerdonmez C, Akova YA, Altinors DD (2007) Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome. Cornea 26:407–413PubMedCrossRefGoogle Scholar
  15. 15.
    Keklikci U, Celik Y, Cakmak SS, Unlu MK, Bilek B (2007) Conjunctival-limbal autograft, amniotic membrane transplantation, and intraoperative mitomycin C for primary pterygium. Ann Ophthalmol Skokie 39:296–301PubMedCrossRefGoogle Scholar
  16. 16.
    Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, Aasuri MK, Nutheti R, Rao GN (2005) Outcome of pterygium surgery: analysis over 14 years. Eye Lond 19:1182–1190PubMedCrossRefGoogle Scholar
  17. 17.
    Yao YF, Qiu WY, Zhang YM, Tseng SC (2006) Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. Graefes Arch Clin Exp Ophthalmol 244:232–236PubMedCrossRefGoogle Scholar
  18. 18.
    Fallah MR, Golabdar MR, Amozadeh J, Zare MA, Moghimi S, Fakhraee G (2008) Transplantation of conjunctival limbal autograft and amniotic membrane vs mitomycin C and amniotic membrane in treatment of recurrent pterygium. Eye Lond 22:420–424PubMedCrossRefGoogle Scholar
  19. 19.
    Shimazaki J, Kosaka K, Shimmura S, Tsubota K (2003) Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium. Ophthalmology 110:119–124PubMedCrossRefGoogle Scholar
  20. 20.
    Ivekovic R, Mandic Z, Saric D, Sonicki Z (2001) Comparative study of pterygium surgery. Ophthalmologica 215:394–397PubMedCrossRefGoogle Scholar
  21. 21.
    Luanratanakorn P, Ratanapakorn T, Suwan-Apichon O, Chuck RS (2006) Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision. Br J Ophthalmol 90:1476–1480PubMedCrossRefGoogle Scholar
  22. 22.
    Katircioglu YA, Altiparmak UE, Duman S (2007) Comparison of three methods for the treatment of pterygium: amniotic membrane graft, conjunctival autograft and conjunctival autograft plus mitomycin C. Orbit 26:5–13PubMedCrossRefGoogle Scholar
  23. 23.
    Memarzadeh F, Fahd AK, Shamie N, Chuck RS (2008) Comparison of de-epithelialized amniotic membrane transplantation and conjunctival autograft after primary pterygium excision. Eye Lond 22:107–112PubMedCrossRefGoogle Scholar
  24. 24.
    Ozer A, Yildirim N, Erol N, Yurdakul S (2009) Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions. Ophthalmologica 223:269–273PubMedCrossRefGoogle Scholar
  25. 25.
    Ozkurt YB, Kocams O, Comez A, Uslu B, Dogan OK (2009) Treatment of primary pterygium. Optom Vis Sci 86:1178–1181PubMedCrossRefGoogle Scholar
  26. 26.
    Jap A, Chan C, Lim L (1999) Conjunctival rotation autograft for pterygium. An alternative to conjunctival autografting. Ophthalmology 106:67–71PubMedCrossRefGoogle Scholar
  27. 27.
    Al FM (2002) Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 109:1752–1755CrossRefGoogle Scholar
  28. 28.
    Rao SK, Lekha T, Mukesh BN, Sitalakshmi G, Padmanabhan P (1998) Conjunctival-limbal autografts for primary and recurrent pterygia: technique and results. Indian J Ophthalmol 46:203–209PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of OphthalmologyEYE & ENT Hospital of Fudan UniversityShanghaiChina
  2. 2.Department of Biostatistics, School of Public HealthFudan UniversityShanghaiChina
  3. 3.Department of Surgery, Division of Otolaryngology - Head and Neck SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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