LETTERS
Comparison of Anchored Conjunctival Rotation Flap and Conjunctival Autograft Techniques in Pterygium Surgery To the Editor: We read with great interest the study by Kim et al,1 which compared the anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. It seems that the 2 groups have reasonably equal recurrence rates; however, on the basis of our experience, there is another noteworthy point that should be mentioned. Recurrence is undesirable but sometimes an inevitable complication after surgical removal of pterygium for many surgeons.2 Although many techniques are described in the literature, no ideal procedure is confirmed to be best for complications.3 One of the most studied surgical techniques is conjunctival autograft, and conjunctival flap is another technique that is studied as well as autografting. Both conjunctival autograft and flap have become an important part of surgical excision of pterygium. Studies have found different recurrence rates with the conjunctival flap technique. Müller et al4 reported a lower recurrence rate with a conjunctival flap (6.9%) compared with the free conjunctival graft (18.5%). Similarly, Kim et al5 found a lower recurrence rate with conjunctival flap (4.7%) compared with autograft (17.6%). However, in a study comparing the pterygium excision techniques, Alpay et al6 found the conjunctival flap technique to have a significantly higher recurrence rate (33.3%) compared with conjunctival autograft (17%). In another study, Aslan et al7 found higher but no significant difference in recurrence rates with conjunctival flap (13%) compared with graft (9%). Apart from the previous comparative studies,
TO THE
EDITOR
Aslan et al used a standardized size of conjunctival flap. Pterygium recurrence has been studied extensively, and the differences in recurrence rates may be affected by many factors and not solely by the superiority of a surgical procedure. However, conjunctival flap size may very well influence the recurrence rate in different degrees, and the standardization of the flap dimension should be provided to report a more realistic recurrence rate. The lack of data about the conjunctival flap size is the major limitation of this study. Financial disclosures/conflicts interest: None reported.
of
Gokcen Gokce, Gokhan Ozge, Tarkan Mumcuoglu, Murat Kucukevcilioglu, Onder Ayyildiz, Cem Ozgonul,
MD MD MD MD MD MD
Department of Ophthalmology, Kayseri Military Hospital, Kayseri, Turkey Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey Department of Ophthalmology, Van Military Hospital, Van, Turkey
REFERENCES 1. Kim SH, Oh JH, Do JR, et al. A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. Cornea. 2013;32:1578–1581. 2. Janson BJ, Sikder S. Surgical management of pterygium. Ocul Surf. 2014;12:112–119. 3. Cagatay HH, Gokce G, Ekinci M, et al. Longterm comparison of fibrin tissue glue and vicryl suture in conjunctival autografting for pterygium surgery. Postgrad Med. 2014;126: 97–103. 4. Müller S, Stahn J, Schmitz K, et al. Recurrence rates after pterygium excision with sliding conjunctival flap versus free conjunctival autograft [in German]. Ophthalmologe. 2007;104:480–483. 5. Kim M, Chung SH, Lee JH, et al. Comparison of mini-flap technique and conjunctival autograft transplantation without mitomycin C in primary and recurrent pterygium. Ophthalmologica. 2008;222:265–271. 6. Alpay A, Ugurbas S, Erdogan B. Comparing techniques for pterygium surgery. Clin Ophthalmol. 2009;3:69–74. 7. Aslan L, Aslankurt M, Aksoy A, et al. Comparison of wide conjunctival flap and
Cornea Volume 34, Number 5, May 2015
conjunctival autografting techniques in pterygium surgery. J Ophthalmol. 2013; 2013:209401.
Screening of Refractive Surgery Candidates for LASIK and PRK To the Editor: We commend the authors1 of this excellent study for formally evaluating the prevalence of abnormal topographies in a large sample size using modern diagnostic corneal imaging technology. Although the prevalence of keratoconus has been described in the oft-quoted literature as roughly 1 in 2000,2–4 many experienced refractive surgeons have long been of the opinion that that these prevalence numbers using early old references (and old technologies such as manual keratometry and retinoscopy) are falsely low. The medical advisory board of TLC Laser Centers (a major LASIK provider in the United States) reported that 10% to 15% of patients who present for LASIK are turned away because of findings related to the risk of ectasia (R. L. Lindstrom, MD, personal communication, December 28, 2013). The prevalence of abnormal corneal scans consistent with forme fruste keratoconus and other ectatic or preectatic conditions is clearly much more common than 1:2000. This article by Torricelli and Associates provides further evidence that ectatic and preectatic conditions remain much more common and a greater concern than would be expected from the literature dating back 15 years or more based on much more crude and insensitive diagnostic technology. One potential bias of this report is that patients presenting for refractive surgery may be less happy with spectacle correction compared with the general population. Nonetheless, we believe that there is no question that the prevalence of abnormal corneas with potentially elevated risk of losing vision due to corneal biomechanical weakness remains much higher than previously estimated. The current article by Torricelli adds to the www.corneajrnl.com |
e13
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Comparison of Anchored Conjunctival Rotation Flap and Conjunctival Autograft Techniques in Pterygium Surgery To the Editor: We read with great interest the study by Kim et al,1 which compared the anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. It seems that the 2 groups have reasonably equal recurrence rates; however, on the basis of our experience, there is another noteworthy point that should be mentioned. Recurrence is undesirable but sometimes an inevitable complication after surgical removal of pterygium for many surgeons.2 Although many techniques are described in the literature, no ideal procedure is confirmed to be best for complications.3 One of the most studied surgical techniques is conjunctival autograft, and conjunctival flap is another technique that is studied as well as autografting. Both conjunctival autograft and flap have become an important part of surgical excision of pterygium. Studies have found different recurrence rates with the conjunctival flap technique. Müller et al4 reported a lower recurrence rate with a conjunctival flap (6.9%) compared with the free conjunctival graft (18.5%). Similarly, Kim et al5 found a lower recurrence rate with conjunctival flap (4.7%) compared with autograft (17.6%). However, in a study comparing the pterygium excision techniques, Alpay et al6 found the conjunctival flap technique to have a significantly higher recurrence rate (33.3%) compared with conjunctival autograft (17%). In another study, Aslan et al7 found higher but no significant difference in recurrence rates with conjunctival flap (13%) compared with graft (9%). Apart from the previous comparative studies,
TO THE
EDITOR
Aslan et al used a standardized size of conjunctival flap. Pterygium recurrence has been studied extensively, and the differences in recurrence rates may be affected by many factors and not solely by the superiority of a surgical procedure. However, conjunctival flap size may very well influence the recurrence rate in different degrees, and the standardization of the flap dimension should be provided to report a more realistic recurrence rate. The lack of data about the conjunctival flap size is the major limitation of this study. Financial disclosures/conflicts interest: None reported.
of
Gokcen Gokce, Gokhan Ozge, Tarkan Mumcuoglu, Murat Kucukevcilioglu, Onder Ayyildiz, Cem Ozgonul,
MD MD MD MD MD MD
Department of Ophthalmology, Kayseri Military Hospital, Kayseri, Turkey Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey Department of Ophthalmology, Van Military Hospital, Van, Turkey
REFERENCES 1. Kim SH, Oh JH, Do JR, et al. A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. Cornea. 2013;32:1578–1581. 2. Janson BJ, Sikder S. Surgical management of pterygium. Ocul Surf. 2014;12:112–119. 3. Cagatay HH, Gokce G, Ekinci M, et al. Longterm comparison of fibrin tissue glue and vicryl suture in conjunctival autografting for pterygium surgery. Postgrad Med. 2014;126: 97–103. 4. Müller S, Stahn J, Schmitz K, et al. Recurrence rates after pterygium excision with sliding conjunctival flap versus free conjunctival autograft [in German]. Ophthalmologe. 2007;104:480–483. 5. Kim M, Chung SH, Lee JH, et al. Comparison of mini-flap technique and conjunctival autograft transplantation without mitomycin C in primary and recurrent pterygium. Ophthalmologica. 2008;222:265–271. 6. Alpay A, Ugurbas S, Erdogan B. Comparing techniques for pterygium surgery. Clin Ophthalmol. 2009;3:69–74. 7. Aslan L, Aslankurt M, Aksoy A, et al. Comparison of wide conjunctival flap and
Cornea Volume 34, Number 5, May 2015
conjunctival autografting techniques in pterygium surgery. J Ophthalmol. 2013; 2013:209401.
Screening of Refractive Surgery Candidates for LASIK and PRK To the Editor: We commend the authors1 of this excellent study for formally evaluating the prevalence of abnormal topographies in a large sample size using modern diagnostic corneal imaging technology. Although the prevalence of keratoconus has been described in the oft-quoted literature as roughly 1 in 2000,2–4 many experienced refractive surgeons have long been of the opinion that that these prevalence numbers using early old references (and old technologies such as manual keratometry and retinoscopy) are falsely low. The medical advisory board of TLC Laser Centers (a major LASIK provider in the United States) reported that 10% to 15% of patients who present for LASIK are turned away because of findings related to the risk of ectasia (R. L. Lindstrom, MD, personal communication, December 28, 2013). The prevalence of abnormal corneal scans consistent with forme fruste keratoconus and other ectatic or preectatic conditions is clearly much more common than 1:2000. This article by Torricelli and Associates provides further evidence that ectatic and preectatic conditions remain much more common and a greater concern than would be expected from the literature dating back 15 years or more based on much more crude and insensitive diagnostic technology. One potential bias of this report is that patients presenting for refractive surgery may be less happy with spectacle correction compared with the general population. Nonetheless, we believe that there is no question that the prevalence of abnormal corneas with potentially elevated risk of losing vision due to corneal biomechanical weakness remains much higher than previously estimated. The current article by Torricelli adds to the www.corneajrnl.com |
e13
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
