Duplo retalho conjuntival com sutura versus autotransplante conjuntival com cola para pterígio primário: estudo prospectivo, randomizado.

Abstract

Introduction: Pterygium is a triangular growth of the conjunctiva that crosses the limbus towards the cornea. It is a fibrovascular proliferative disease that affects the ocular surface, leading to ocular irritation and various visual disturbances. Although clinical treatment aims to provide relief of symptoms, the only effective treatment is surgery, and there are multiple techniques for therapeutic approach. Our work describes the double conjunctival flap rotation technique, comparing it with conjunctival autograft in a prospective and randomized study. Objectives: To compare the conjunctival autograft technique versus double conjunctival flap rotation for the treatment of primary pterygium, evaluating recurrence, cosmetic aspects and postoperative complications. Methods: Eighty-one patients aged over 18 and under 80 years with primary pterygium and no ocular surface disease were included in the study. The patients were randomly divided into two groups according to the procedure performed. One group underwent conjunctival autograft (group 1) and the other group underwent double conjunctival flap rotation surgery (group 2). The patients were followed up for a period of 6 months. Recurrence of fibrovascular tissue invading the cornea was considered recurrence. This project was approved by the CEP of HUUFMA. The data were analyzed using SPSS (v. 26). All statistical associations were set at an alpha significance level of less than 0.05. Results: A total of 81 patients were included in the study, 34 underwent conjunctival autograft (group 1) and 47 underwent double rotated conjunctival flap (group 2). The mean age of the patients was 54.8 ± 13.1 years in group 1 and 51.9 ± 12.6 years in group 2 (p=0.542). Females predominated in both groups, corresponding to 61.7% of patients in group 1 and 57.4% of patients in group 2 (p = 0.696). Regarding the degree of pterygium, according to Tan's classification, in the conjunctival autograft group, 26.5% had grade I pterygia, 67.6% had grade II pterygia and 5.9% had grade III pterygia, while in the double conjunctival flap group, 34% had grade I pterygia, 46.8% had grade II pterygia and 19.1% had grade III pterygia, with no statistically significant difference between the groups. Regarding the presence of symptoms in the postoperative period, there was no difference between the groups. Regarding the presence of complications, such as conjunctival granuloma and conjunctival retraction, the groups were similar without statistically significant difference. There were 4 cases of recurrence (11.8%) in group 1 and 2 cases (4.3%) in group 2 (p=0.203). There was no statistically significant difference between the groups in terms of cosmetic aspect (p=0.235). Conclusion: Double conjunctival flap rotation and conjunctival autograft are effective in the treatment of primary pterygium, with similar complication rates and cosmetic results. The double conjunctival flap rotation technique showed a trend towards lower recurrence rates, although this difference was not statistically significant.