Cosmetic outcome of femtosecond laser-assisted pterygium surgery

Darren Shu Jeng Ting, Yu-Chi Liu, Yi Fang Lee, Angel Jung Se Ji, Tien-En Tan, Hla M Htoon, Jodhbir S Mehta, Darren Shu Jeng Ting, Yu-Chi Liu, Yi Fang Lee, Angel Jung Se Ji, Tien-En Tan, Hla M Htoon, Jodhbir S Mehta

Abstract

Background: To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors.

Methods: This was a prospective interventional case series (NCT02866968). We included 29 patients (29 eyes) with primary pterygium who underwent FLAPS. Cosmetic outcome was graded by two graders (an ophthalmology resident and an experienced ophthalmologist) using Hirst classification system (1-4 = excellent-poor). Weighted Cohen's kappa analysis was performed to examine the intra- and inter-rater reliability. The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients (r).

Results: The preoperative severity of pterygium (Tan grading system) was mild/atrophic (7%), moderate/intermediate (62%), and severe/fleshy (31%). An ultrathin CAG (mean thickness of 74.5 ± 9.8 μm) was fashioned intraoperatively. An excellent cosmetic outcome of FLAPS (median ± IQR) was observed at 3 months (1.0 ± 1.0) and remained similar at 6 months (1.0 ± 0.0) and 12 months (1.0 ± 0.0) postoperatively. At final follow-up, 27 (93%) patients achieved good-to-excellent cosmetic outcome, with 1 (3%) patient having a poor outcome due to incomplete pterygium removal. Weighted kappa analysis of Hirst grading system showed excellent intra-rater (κ = 0.86-0.95) and inter-rater reliability (κ = 0.84-0.88). There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness (r = 0.38, P = 0.06) but not with age, gender, preoperative pterygium severity, or intraoperative CAG thickness.

Conclusions: FLAPS can result in an excellent cosmetic outcome, which may be attributed to the beneficial effect of an ultrathin CAG.

Trial registration: ClinicalTrials.gov , NCT02866968 . Registered in July 2016.

Keywords: Cosmesis; Cosmetic outcome; Femtosecond laser; Pterygium; Pterygium surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Illustrations of the cosmetic outcomes of patients with different grades of pterygium severity (based on Tan grading system) at various postoperative time points, including early (3 months), intermediate (6 months), and late (12 months) follow-up period. Preoperative and postoperative pictures of the ocular surface of the patient with mild pterygium (a-d), moderate pterygium (e-h), and severe pterygium (i-l). Excellent outcomes were achieved in all these three patients
Fig. 2
Fig. 2
Examples of grading of postoperative cosmetic outcome following femtosecond laser-assisted pterygium surgery. a An excellent outcome with a white, normal looking conjunctiva. b A good outcome with mild generalized conjunctival vascular injection. c A fair outcome with localized conjunctival vascular injection at the surgical site only (blue arrow). d A poor outcome with localized conjunctival vascular injection and additional conjunctival changes, including conjunctival scarring, puckering and recurrence. In this case, the poor outcome was related to an incomplete removal of the pterygium (red arrow)

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