Meta-analysis Of Recurrent Pterygium With Corneal Limbal Stem Cell Autograft Transplantation And Amniotic Membrane Transplantation

Objective:In terms of the surgical treatment of pterygium,the recurrence rate is high after simple pterygium excision,and there is no clear selection criteria for the surgical treatment of recurrent pterygium.This study analyzed the two surgical methods of pterygium excision combined with corneal limbal stem cell autograft transplantation(CLAG)and pterygium excision combined with amniotic membrane transplantation(AMT)by meta-analysis.To compare the recurrence rate,postoperative complication rate and corneal wound healing,we hope to find the significant differences between them.Methods:All published clinical studies on pterygium excision combined with CLAG and pterygium excision combined with AMT in the treatment of recurrent pterygium from the establishment of the database to 2022-12 were retrieved by computer.Databases include Pub Med,Embase,The Cochrane Library,Web of Science,and Chinese databases include China National Knowledge Network(CNKI),Wanfang Database and Weipu Chinese Journal Full-text database.The literatures were screened according to inclusion and exclusion criteria,and the quality of the included literatures was evaluated using the Randomized Controlled Trial(RCT)risk assessment tools in the Cochrane manual.General characteristics of the literatures and the data required for this study were extracted.Designed tables were used to summarize and process the collected data,and statistical analysis was performed using Review Manager 5.4 and Stata software.The recurrence rate,postoperative complication rate,corneal epithelial healing time and other indexes were analyzed.Result:A total of 466 related studies were retrieved.According to the inclusion and exclusion criteria,30 relevant literatures with a total of2340 eyes were included.A total of 1189 eyes underwent corneal limbal stem cell autograft transplantation and 1151 eyes underwent amniotic membrane transplantation.The odds ratio(OR)of recurrence rate and incidence of postoperative complications were used as the effect size for counting data,and mean standard deviation(SMD)of postoperative healing time of corneal epithelium was used as the effect size for measuring data,and 95% confidence interval(CI)was calculated.The results of meta-analysis showed that: In terms of postoperative recurrence rate,the overall recurrence rate was 5.30%(63/1189 eyes)in corneal limbal stem cell autograft transplantation group and 19.2%(221/1151eyes)in amniotic membrane transplantation group.Compared with amniotic membrane transplantation,corneal limbal stem cell autograft transplantation was more effective in reducing the postoperative recurrence rate of recurrent pterygium.The difference between the two groups was statistically significant(OR = 0.24,95%CI: 0.18 ～ 0.32,P <0.00001).In terms of postoperative complications,the overall complication rate of corneal limbal stem cell autograft transplantation group was 0.97%(4/411 eyes)and that of amniotic membrane transplantation group was 4.15%(16/385 eyes).Compared with amniotic membrane transplantation,corneal limbal stem cell autograft transplantation was more effective in reducing the postoperative complication rate of recurrent pterygium.The difference between the two groups was statistically significant(OR = 0.27,95%CI: 0.10 ～ 0.72,P =0.009).In terms of postoperative healing time of corneal epithelium,pterygium excision combined with corneal limbal stem cell autograft transplantation was shorter than amniotic membrane transplantation,and the difference between the two groups was statistically significant(SMD=-1.33,95%CI:-1.66 ～-1.00,P < 0.00001).Conclusion:Analysis of two surgical treatments for recurrent pterygium showed that CLAG was more effective than AMT in reducing the recurrence rate,reducing the incidence of postoperative complications and shortening the healing time of corneal epithelium.