Comparison Of Postoperative Ocular Surface Of Primary Pterygium Excision Combined With Either Limbal Stem Cell Transplantation Or Amniotic Membrane Transplantation:a Meta-analysis

Background:Pterygium is a common ocular surface disease.Surgical excision is currently the most effective treatment for primary pterygium.Both pterygium excision combined with limbal stem cell transplantation(LSCT)and amniotic membrane transplantation(AMT)can effectively treat primary pterygium.However,the effects of these two different surgical operations are not exactly the same.There is still no consensus on which one is better or worse.Objective:To compare the effectiveness of pterygium resection combined with limbal stem cell transplantation(LSCT)and amniotic membrane transplantation(AMT)on the postoperative ocular surface of primary pterygium.Methods:This study used Meta-analysis and developed a search strategy according to the PICO(Population,Intervention,Comparison,Outcome)principles.All relevant studies on the primary pterygium excision combined with either LSCT or AMT conducted were extracted from English and Chinese databases such as PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases.The search period was set from January 2017 to December 2022.The break-up time(BUT)and Schirmer I test(SIt)at 1 month(m),3m,and 6m after surgery,and the postoperative corneal epithelial healing time,complication rate in 6m,and recurrence rate in 12m after surgery were selected as the outcomes.The data of these outcomes were extracted from the relevant studies.The Cochrane risk bias assessment tool was applied to evaluate the quality of the final screened literature.Statistical analysis was performed using Review Manager 5.3 and Stata 15.1 software.The measurement data were expressed as mean difference(MD)and 95%confidence interval(CI),and the count data were expressed as relative risk(RR)and 95%CI.Results:A total of 311 relevant papers were retrieved,and 13 papers were finally included after the screening.A total of 1152 patients(1207 eyes)were included in the study.There were 580 patients(607 eyes)with primary pterygium underwent pterygium excision combined with limbal stem cell transplantation(LSCT group)and 572 patients(600 eyes)with primary pterygium underwent pterygium excision combined with amniotic membrane transplantation(AMT group).There was no statistical difference in the postoperative BUT(1m)between the LSCT group and the AMT group(MD=-0.77,95%CI:-1.93～0.39,Z=1.30,P=0.19).Compared with patients of the AMT group,patients of the LSCT group had a longer duration of BUT(3 and 6m)postoperatively(3m:MD=0.38,95%CI:0.14～0.62,Z=3.15,P=0.002;6m:MD=0.88,95%CI:0.58～1.18,Z=5.74,P<0.00001).There was no statistical difference in the results of postoperative Slt(1m)between the LSCT group and the AMT group(MD=-0.21,95%CI:-0.43～0.00,Z=1.93,P=0.05).Patients of the LSCT group had better results of SIt(3 and 6m)than those of the AMT group after surgery(3m:MD=0.31,95%CI:0.09～0.53,Z=2.76,P=0.006;6m:MD=0.36,95%CI:0.10～0.62,Z=2.70,P=0.007).Compared with the AMT group,the postoperative corneal epithelial healing time was shorter(MD=-1.48,95%CI:-2.41～-0.55,Z=3.11,P=0.002),the postoperative complication rate was lower(RR=0.45,95%CI:0.22-0.92,Z=2.19,P=0.03)and the postoperative recurrence rate was lower in the LSCT group(RR=0.30,95%CI:0.18-0.48,Z=4.93,P<0.00001).In addition,there was no publication bias in any of the outcome measures included in the study.Conclusions:The effectiveness of pterygium resection combined with limbal stem cell transplantation(LSCT)was better than amniotic membrane transplantation(AMT)on the postoperative ocular surface of primary pterygium.