OUTCOME OF PTERYGIUM EXCISION AND CONJUNCTIVAL AUTOGRAFT TECHNIQUE AT THE PACIFIC EYE INSTITUTE, SUVA, FIJI. A RETROSPECTIVE STUDY

Introduction: Pterygium is a common eye problem and it is the second most common eye surgery performed at the Pacific Eye Institute (PEI) / Eye Department, Colonial War Memorial Hospital (CWMH) in Fiji. The standard surgical technique used is pterygium excision and conjunctival autograft with sutures. The outcomes for this technique had never been studied locally hence this study investigated its outcomes and reported on mean change in visual acuity from baseline to followup. PEI is also a training hub for aspiring Ophthalmologists in the South Pacific so this study also looked at whether the level of surgical experience played a role in surgical outcomes. Trainees are enrolled in Postgraduate Diploma of Opthalmology (PGDO) and Masters of Medicine (MMED) Ophthalmology Program which is provided by the Fiji National University.
Method(s): This was an observational, retrospective series of cases that included 79 eyes of 79 patients with primary and recurrent pterygium who had undergone pterygium excision surgery with conjunctival autograft. These surgeries were performed by trainees and consultant ophthalmologists. Data were collected from patient records and data included patient demograpahics, surgical complications, post operative visual outcomes and trainee and consultant surgical outcomes. Statistical analysis was done using Microsoft Excel 2016 and GraphPad Prism 8.2.1. Descriptive analysis was performed for gender, ethnicity, age, recurrence rate and levels of surgical experience. Odds ratios was calculated using Chi square test and statistical significance was tested by Paired T test for visual acuity (LogMar). P≤0.05 was considered to be statistically significant.
Results: The study included 79 eyes of 79 patients. There were 48 I-Taukei (IT), 29 Fijian of Indian Descent (FID) and 2 Others. There were 42 right eyes and 37 left eyes. 91% of pterygiums were on the nasal aspect. There were more males to females, 45 and 34 respectively. The mean age of the patients were 52.97±12.46 and the mean follow up time
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was 2.93 ±2.28 months. Seven eyes had pterygium recurrence with a recurrenc rate of 9%. Other post operative complications included graft dehisence 2.5%(n=2), granuloma 1%(n=1), corneal scar 1% (n=1%), graft edema 7.6%(n=6), steroid responder 2.5%(n=2) and a missing graft 1% (n=1). This study reported that mean preoperative best corrected visual acuity improved post operatively and this was statistically significant (P < 0.001). This study also showed that PGDO trainees had higher recurrence rate of 18.75% (n=3) as compared to the more surgically experienced trainees and the consultants. Mean time to recurrence was shortest for the MMED 1 trainees at 1.38 months and the longest was at 7.83 months for the MMED3 trainees. Post operative complications occurred more on eyes operated on by the trainees compared to those operated on by the consultants. Mean preoperative best corrected visual acuity improved post operatively across all surgical levels however was only statistically significant for the MMED1 and the consultants with P<0.001 for both groups.
Conclusion: This study has described the demographics of this unique study population and has reported on the complications post operativley. It has also proven that surgery does improve post operative vision and shares the sentiment with other studies that there is a learning curve to this procedure.