A randomized clinical trial of freeze-dried amniotic membrane transplantation and conjunctival-limbal graft for pterygium excision and evaluation of conjunctival inflammation marker in tears

  • Made Susiyanti Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo-Kirana Hospital, Jakarta, Indonesia
  • Manoa Panjaitan Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo-Kirana Hospital, Jakarta, Indonesia
  • Grace Wangge South East Asian Ministers of Education Organization, Jakarta, Indonesia https://orcid.org/0000-0002-5416-273X
  • Tjahjono Darminto Gondhowiardjo Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo-Kirana Hospital, Jakarta, Indonesia
Keywords: amniotic membrane, interleukin-6, pterygium
Abstract viewed: 150 times
PDF downloaded: 69 times
HTML downloaded: 7 times
EPUB downloaded: 19 times

Abstract

BACKGROUND Minimizing inflammation on the ocular surface after pterygium surgery is essential to prevent recurrence. Currently, limited data are available for the comparison between freeze-dried amniotic membrane (FD-AM) and conjunctival–limbal graft (CLG). Therefore, this study aimed to assess conjunctival inflammation and the interleukin (IL)-6 levels in tears after pterygium excision between both techniques.

METHODS This prospective, single-blinded, randomized clinical trial included 26 eyes of 26 patients with primary or recurrent pterygium and who were indicated for pterygium surgery at Cipto Mangunkusumo Hospital, Indonesia from October 2017 until February 2018. The patients were scheduled for pterygium excision with FD-AM or CLG based on block randomization. Conjunctival inflammation and the level of IL-6 in tears were measured on day-7 and -28 after surgery.

RESULTS The 26 eyes (13 in each group) were subjected to a complete 1-month follow-up period. Day-7 after the surgery, severe inflammation occurred in 4/13 (31%) eyes having FD-AM and 8/13 eyes (62%) having CLG (p = 0.59). The IL-6 tear level increased similarly in FD-AM (22.85 pg/ml) and CLG (23.51 pg/ml) in (p = 0.78). No severe adverse events occurred.

CONCLUSIONS Pterygium excision using FD-AM yield a milder inflammation than CLG on day-7 and -28 after surgery. The tear IL-6 levels similarly increased on day-7.

References

  1. Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016;2:CD011349. https://doi.org/10.1002/14651858.CD011349.pub2

  2. Liu L, Wu J, Geng J, Yuan Z, Huang D. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. BMJ Open. 2013;3(11):e003787. https://doi.org/10.1136/bmjopen-2013-003787

  3. Cajucom-Uy H, Tong L, Wong TY, Tay WT, Saw SM. The prevalence of and risk factors for pterygium in an urban Malay population: the Singapore Malay Eye Study (SiMES). Br J Ophthalmol. 2010;94(8):977-81. https://doi.org/10.1136/bjo.2008.150847

  4. Khan FA, Khan Niazi SP, Khan DA. The impact of pterygium excision on corneal astigmatism. J Coll Physicians Surg Pak. 2014;24(6):404-7.

  5. Kheirkhah A, Casas V, Sheha H, Raju VK, Tseng SC. Role of conjunctival inflammation in surgical outcome after amniotic membrane transplantation with or without fibrin glue for pterygium. Cornea. 2008;27(1):56-63. https://doi.org/10.1097/ICO.0b013e31815873da

  6. Rincon M. Interleukin-6: from an inflammatory marker to a target for inflammatory diseases. Trends Immunol. 2012;33(11):571-7. https://doi.org/10.1016/j.it.2012.07.003

  7. Tanaka T, Narzaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295. https://doi.org/10.1101/cshperspect.a016295

  8. Cha DM, Kim KH, Choi HJ, Kim MK, Wee WR. A comparative study of the effect of fibrin glue versus sutures on clinical outcome in patients undergoing pterygium excision and conjunctival autografts. Korean J Ophthalmol. 2012;26(6):407-13. https://doi.org/10.3341/kjo.2012.26.6.407

  9. Mamede AC, Carvalho MJ, Abrantes AM, Laranjo M, Maia CJ, Botelho MF. Amniotic membrane: from structure and functions to clinical applications. Cell Tissue Res. 2012;394(2):447-58. https://doi.org/10.1007/s00441-012-1424-6

  10. Gupta A, Kedige SD, Jain K. Amnion and chorion membranes: potential stem cell reservoir with wide applications in periodontics. Int J Biomater. 2015;2015:274082. https://doi.org/10.1155/2015/274082

  11. Lee HN, Bernardo R, Han GY, Kim GY, Kim JS, Jung WY, et al. Human amniotic membrane extracts have anti-inflammatory effect on damaged corneal epithelial cells in vitro. J Hard Tissue Biology. 2016;25(3):282-7. https://doi.org/10.2485/jhtb.25.282

  12. Kheirkhah A, Nazari R, Nikdel M, Ghassemi H, Hashemi H, Behrouz MJ. Postoperative conjunctival inflammation after pterygium surgery with amniotic membrane transplantation versus conjunctival autograft. Am J Ophthalmol. 2011;152(5):733-8. https://doi.org/10.1016/j.ajo.2011.04.013

  13. Lee SY, Han SJ, Nam SM, Yoon SC, Ahn JM, Kim TI, et al. Analysis of tear cytokines and clinical correlations in Sjögren syndrome dry eye patients and non-Sjögren syndrome dry eye patients. Am J Ophthalmol. 2013;156(2):247-53. https://doi.org/10.1016/j.ajo.2013.04.003

  14. Yoon KC, Jeong IY, Park YG, Yang SY. Interleukin-6 and tumor necrosis factor-alpha levels in tears of patients with dry eye syndrome. Cornea. 2007;26(4):431-7. https://doi.org/10.1097/ICO.0b013e31803dcda2

Published
2020-12-29
How to Cite
1.
Susiyanti M, Panjaitan M, Wangge G, Gondhowiardjo TD. A randomized clinical trial of freeze-dried amniotic membrane transplantation and conjunctival-limbal graft for pterygium excision and evaluation of conjunctival inflammation marker in tears. Med J Indones [Internet]. 2020Dec.29 [cited 2021Jan.26];29(4):359-65. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/3818
Section
Clinical Research