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Autogreffes conjonctivales et conjonctivo-limbiques versus greffe de membrane amniotique dans le traitement chirurgical des ptérygions primaires : revue systématique des 30 dernières années

Introduction: Meta-analysis and systemic reviews of randomized-controlled trials (RCTs) failed to show a statistical superiority of LCA over AMG for primary pterygium surgery. Therefore, the place of AMG in the surgical therapeutic arsenal remains to be defined. The main objective of this review is to compare the “real-life” effectiveness of free conjunctival autograft (CAT) with LCA, AMG and combined surgical techniques in terms of pterygium recurrence based on the retrospective published data in the literature, providing new insights and perspective for the management of this very common disease.

Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3 months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured.

35 real-life retrospective subgroups gathering a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were lower for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6,03% and 23,0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%). 

Amniotic membranes have several biological properties including anti-angiogenic, anti-inflammatory and anti-fibrotic effects. healing phase and a suture resorption phase, that are both associated with inflammation. Associating AMG with fibrin glue for primary pterygia has a double advantage: the use of AMG preserves the conjunctiva of the patient in case they require a future glaucoma procedure or in case of recurrences. On the other hand, recent evidence suggests that the combination of AMG with CAT or LCA can achieve an even lower recurrence rate than what can be achieved with either technique alone. Therefore, we must bear in mind that CAT and LCA yield the lower recurrence rate and have always to be considered as a first intention therapy in primary pterygium surgery.

AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence.