Real World Outcomes And Follow-Up Issues With 'Perfect' Pterygium Surgery In The Nhs

In 2008, Hirst reported results of the ‘Pterygium Extended Removal followed by Extended Conjunctival Transplantation (PERFECT) technique with a very low recurrence rate (0.05% at one year). Previous studies have reported >90% of pterygia reoccur within one year. 

The Scottish Index of Multiple Deprivation (SIMD) is a relative measure of deprivation consisting of seven domains including employment, education and crime. Previous ophthalmic studies have associated SIMD with delayed presentation. We have been aware of increasing numbers of patients presenting with pterygia in Glasgow, Scotland, undergoing operative intervention and then not attending follow up.

We aimed to analyse the relationship between recurrence, follow up rate and SIMD. 

Gartnavel General Hospital, Greater Glasgow and Clyde

We performed a retrospective audit of all patients who underwent pterygium surgery since 2015 using PERFECT technique principles (large Tenon’s excision and conjunctival autograft) by a single surgeon. 

57 patients were identified. Median SIMD decile was 4 (range 1-10). 

55/57 (96.5%) attended the first follow-up (median 16 days). 41/57 (71.9%) attended second review (median 93 days). 30/57 (52.6%) attended third review (median 375 days).  One patient had minor recurrence by 1 year (defined as lesion crossing limbus). 

Two patients (3.5%) ‘did not attend’ the 1st post-operative follow up appointment. SIMD decile score was 1 for both patients.  16 patients ‘did not attend’ or were lost to follow up at second follow-up appointment. Mean SIMD decile score was 3 (median 2, range 1-10). 27/57 patients (47.4%) did not attend the 3rd post-operative follow up clinic appointment; mean SIMD score 3 (median 2, range 1-10). 

Clinic non-attendance remains a current problem within the NHS (7.6% in June 2023)5.  Lower socio-economic status has been associated with health inequality and missed clinic attendance6. This prevented us providing sufficient data regarding recurrence. We wish to highlight these issues as limiting factors in reporting recurrence rates, and also appeal for a consensus on an agreed time period and definition of recurrence to enable standardized reporting. Otherwise, surgeons may inaccurately assume their results are perfect, without the necessary evidence.