A recent study conducted at Zhongshan Hospital of Xiamen University sheds light on the postoperative recurrence rates of pterygium, identifying significant risk factors related to systemic inflammation. Pterygium, characterized by abnormal growth of conjunctival tissue, can lead to vision problems and often recurs after surgical treatment, making its management clinically challenging.
The research, which evaluated 196 patients who underwent pterygium surgery between January 2017 and January 2018, revealed the overall recurrence rate to be 7.65%. Among these patients, 6.13% from the primary pterygium group experienced recurrence, as opposed to 15.15% among those with recurrent pterygium. With follow-ups averaging nearly two years, the study aimed to determine how systemic factors, particularly inflammatory markers, might predict outcomes following surgery.
The findings indicated two considerable risk factors for recurrence: the preoperative neutrophil to lymphocyte ratio (NLR) and the grade of pterygium. Notably, the study reported, "The preoperative NLR and pterygium grade were significantly associated with recurrence." Specifically, elevated NLR was linked with increased recurrence probability, with odds ratios indicating over four times greater risk when NLR was high.
Understanding what drives pterygium formation and recurrence has been the focus of numerous studies, as long-term UV exposure remains the most established risk factor. Local and systemic inflammation, often evidenced by biomarkers such as NLR, are believed to also play significant roles. Symptoms of pterygium can range from minor discomfort to serious vision impairment, often depending on the severity categorized by the location and growth extent.
Out of the participants, most were female, with ages spanning from 24 to 83. Those suffering from hypertension or diabetes were also noted, but neither condition significantly affected recurrence rates based on the study data. Rather, surgical techniques have evolved to reduce recurrence, including conjunctival autografting, which has shown promise with lower recurrence compared to older methods.
The study points out, "Our results demonstrate NLR is associated with recurrence in patients with pterygium, indicating the immune system plays an important role in this disease." These insights not only inform clinicians about potential preoperative assessments but also suggest ways to tailor postoperative care strategies more effectively.
The surgical procedure involved was detailed, emphasizing conjunctival autografting, which involves excising the pterygium and transplanting conjunctival tissue over the affected area. This method has shown to produce lower recurrence rates than older techniques, which often left the sclera bare, leading to higher regrowth chances. Outcomes from previous studies on conjunctival autografting have varied widely, with recurrence estimates ranging anywhere from 5% to 39%, underscoring the importance of patient selection and surgical proficiency.
Both univariate and multivariate logistic regression analyses conducted within this study confirmed the independent association of high NLR and more advanced pterygium grades with recurrence. These findings deepen the existing knowledge surrounding pterygium surgery and advocate for careful evaluation of patients' systemic inflammatory status as part of the preoperative process.
Limitations of the study were acknowledged, such as the relatively small sample size and potential biases inherent to retrospective analyses. Further research with larger cohorts is necessary to solidify the established links between systemic inflammation indicators and surgical outcomes. Drug interventions could also be explored to modulate inflammation proactively for those identified at higher risk.
Conclusively, this study brings potential future benefits to patient selection outcome prediction and improving long-term care strategies, paving the way for enhanced interventions aimed at reducing pterygium recurrence.