The Efficacy of Combined Bandage Contact Lens and Nasal Margin Suture Fixation in Pterygium Patients and Its Impact on Inflammatory Factors

The Efficacy of Combined Bandage Contact Lens and Nasal Margin Suture Fixation in Pterygium Patients and Its Impact on Inflammatory Factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Efficacy of Combined Bandage Contact Lens and Nasal Margin Suture Fixation in Pterygium Patients and Its Impact on Inflammatory Factors Xuewei Liu, Xuezhang Zhao, Yuhong Chen, Can Zheng, Qingdong Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6926634/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To evaluate the efficacy of the combination of bandage contact lens and nasal margin suture fixation in pterygium resection, specifically examining the effects on IL-6, TNF-α, and TGF-β1. Methods: This prospective research involved the selection of 74 patients who received limbal conjunctival autograft (LCAG) procedures at Cheng Fei Hospital between June 2022 and June 2024. Participants were categorized into two groups based on the fixation techniques employed for the autograft. Group 1 utilized bandage contact lens combined with nasal side suture, while Group 2 employed traditional interrupted suture. All patients underwent a preoperative examination and regular postoperative follow-up. Results: Group 1 exhibited a greater reduction in operative time compared to Group 2( P <0.001). On the 2nd day postoperatively, the thickness of the autograft in Group 1 was found to be greater compared to Group 2 ( P <0.001). However, this trend reversed by the 1st week postoperatively( P <0.001). On the 1st month postoperatively, there was no statistical divergence( P =0.461).On the 2nd day, 3rd day and 1st week postoperatively, the Visual Analog Scale (VAS) scores for group 2 were consistently higher than those for group 1 (all P <0.001). Compared with the levels of IL-6, TNF-α, and TGF-β1 on the 2nd day postoperatively, all cytokines were statistically significantly increased in both groups at one week postoperatively (all P <0.05) and decreased by one month postoperatively(all P <0.05). Furthermore, on the 1st week and 1st month postoperatively, the levels of IL-6 and TNF-α in group 1 were lower than those in group 2 (all P <0.05).However, At these various time points,the levels of TGF-β1 was no statistical divergence( P <0.05).Regarding postoperative complications, including corneal scar,sub-conjunctival hemorrhage, graft retraction, graft edema and recurrence, no significant differences were observed between the two groups. Conclusions: The combination of bandage contact lens and nasal margin suture fixation is a safe and effective method for treating pterygium, as it reduces postoperative inflammatory reactions and enhances patient comfort. Pterygium Conjunctival autograft Complication Inflammatory factors Figures Figure 1 Figure 2 Figure 3 Introduction Pterygium is a common focal fibrovascular proliferation of conjunctival tissue on the cornea, induced by ultraviolet light, with an adult incidence rate ranging from 7–33% [ 1 ] . It not only affects the cosmetic appearance of the eye but also invades the cornea, causes progressive astigmatism or blocks the pupil area, leading to vision loss and even excessive growth that restricts eye movement. The exact pathogenesis of primary pterygium is complex and remains uncertain, contributing to a high postoperative recurrence rate. With a low recurrence rate and a favorable safety profile, LCAG has emerged as the primary choice for pterygium resection [ 2 ] . Traditional LCAG employs interrupted sutures to secure the autograft; however, the removal of these sutures can lead to pain and bleeding, as well as complications such as infection, inflammation, abscesses, button holes, and prolonged operation time. In 2004, Koranyi et al. [ 3 ] first proposed the use of adhesive methods for securing autograft. Fibrin glue and autologous serum not only enhance patient comfort but also reduce surgical duration, although they are associated with a higher incidence of complications, including granuloma, detachment or displacement of the autograft compared to suture methods [ 4 – 6 ] . Fibrin glue, derived from human plasma, poses risks of transmitting prion and parvovirus B19 infections, as well as potential postoperative inflammation and allergic reactions. Furthermore, due to its high cost, fibrin glue has not been widely adopted in my country. Related studies have indicated that thermal coagulation may help mitigate detachment or displacement of the autograft [ 7 ] . However, there are currently limited reports on thermal coagulation, and no standardized protocols exist regarding the energy, duration, and degree of electrocoagulation. Thus, the feasibility and safety of this method is acknowledged. The fixation methods for conjunctival autograft have been a subject of debate, primarily due to variations in the stability of autograft, economic costs, surgical duration, and patient comfort. In response to these challenges, we developed a modified surgical technique tailored to clinical needs, which integrates the nasal side sutures with bandage contact lens. This approach retains the nasal side sutures to enhance the stability of the autograft while employing bandage contact lens in place of limbal side sutures, thereby minimizing patient discomfort and streamlining the surgical process. We compared the efficacy and safety of this modified method with the conventional interrupted suture technique in the treatment of primary pterygium. 1. Patients and methods Patients This study was approved by the Research Ethics Committee of Cheng Fei Hospital and adhered to the principles outlined in the Declaration of Helsinki (No.2023009). The sample size necessary for the research was determined using G*power 3.1 software, with an established medium effect size of f =0.25, a statistical test power of 1- β =0.9, and a significance level of α =0.05 [8] . The findings suggested that a minimum of 36 subjects was essential for each group. This prospective study selected 74 patients who underwent LCAG at Cheng Fei Hospital from June 2022 to June 2024, based on established inclusion and exclusion criteria. Participants were categorized into two groups based on the fixation techniques employed for the autograft: Group 1 utilized bandage contact lens combined with nasal side suture, while Group 2 employed traditional interrupted suture. The inclusion criteria were as follows: according to Tan classification [9] , the diagnosis of primary nasal pterygium was classified as T2 (moderate) or T3 (severe), and one of the following surgical indicators was met: progressive growth of the pterygium, proximity to the visual axis causing astigmatism, pain or congestion, and limited eye movement [10] . The exclusion criteria included: 1) pseud, recurrent, temporal or bilateral pterygium; 2) a history of ocular surface surgery; 3) ocular trauma, ocular inflammation, glaucoma, fundus diseases, or other ophthalmic conditions; 4) severe mental illness, autoimmune diseases, or recent use of immunosuppressive drugs; 5) incomplete data collection. Surgical Procedure The conjunctiva was incised 2 to 3 mm outside the corneal limbus, followed by the careful peeling off of the conjunctiva and pterygium. The pterygium was clipped 2 mm before the lacrimal mound to avoid damaging the medial rectus muscle. The head of the pterygium was reversed for examination, and any remaining tissue from the cornea and sclera was excised. Cautery was employed to control bleeding. All procedures were conducted by the same surgeon. A free conjunctival flap containing limbal stem cells, with an incisal margin entering the transparent cornea by 1 mm, was utilized as the graft. The epithelial surface of the graft was placed onto the wound surface of the pterygium. In Group 1:10-0 nylon suture was used to suture the implant and the implant bed at the nasal corner, and bandage contact lens was weared after fully spreading the implant (Figure 1) .In Group 2: Suture the implant with 10-0 nylon thread at the four directions of the implant.Finally, the bandage contact lens was applied (Figure 1). The donor site of the conjunctiva was left unsutured in both groups. Following the removal of the eyelid opener, the patient was instructed to blink to assess the stability of the implant. Then Levofloxacin eye gel (Hubei Grand Pharmaceutical Co., Ltd., approval number: H20150119) was applied, and the eye was bandaged for 48 hours. Levofloxacin eye gel was administered three times daily, and 0.1% tobramycin-dexamethasone eye ointment (S.a.alcon-couvreur N.V, approval number: H20150119) was given four times daily after epithelial repair, with a gradual tapering of doses over the course of one month. Sutures were removed on the 10th days postoperatively and the bandage contact len was removed on the 1st week after surgery. Follow-Up examination All patients underwent a preoperative examination and regular postoperative follow-up. The operation time, Tan grade, and graft size for each patient were recorded. Additionally, VAS score was used to evaluate the corneal irritation symptoms on the 2nd day, 3rd day and 1st week after operation [11] . Anterior segment optical coherence tomography (AS-OCT) (Company: Spectralis Technology, Model: Spectralis OCT) was employed to measure the thickness of the autograft on the 2nd day, 1st week, and 1st month following surgery. A 75 μL glass capillary tube was placed in the lower fornix conjunctival sac of the patient, and siphoning was used to collect tear samples on the 2nd day, 3rd day, and 1st week postoperatively. Then these samples were transferred to a 0.5 ml centrifuge tube and immediately centrifuged and stored at -80°C. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to detect the concentrations of IL-6, TNF-α, and TGF-β1. Human ELISA Kits for IL-6 (U96-1510E), TNF-α (U96-3716E), and TGF-β1 (U96-1114E) were procured from YOBIBIO (Shanghai,China). The specific experimental equipment is as follows in the table (Table 1). Follow-up observations adverse reactions may include transplantation or detachment of graft, persistent nonunion of the graft, infection, conjunctival granuloma, scleral lysis, and corneal pits, among others. Table 1. Experimental Instruments Name Company Model Water-proof electric heating constant temperat Shanghai Yuejin Medical Instruments Co., Ltd. PYX-DHS Centrifuge Shanghai Anting Scientific Instrument Co., Ltd. TGL-168 Vortex mixer Shanghai Qingpu Huxi Instrument Factory XW-80A Electric thermostaticdrying oven Shanghai Jing Hong Laboratory Instrument Co.,Ltd. DHG-9023A Microplate washer Thermo Wellwash 4 MK2 Continuous dispenser TOMOS LIFE SCIENCE Group 0.1～50ml Enzyme-linked immunosorbent assay instrument Thermo DENLEY DRAGON Wellscan MK 3 Statistical Analysis The data were analyzed using SPSS 24.0 statistical software. Counting data were presented either as absolute numbers or percentages, and measuring data that followed a normal distribution were given as mean ± standard deviation ( ). The difference of VAS score, thickness of conjunctiva autograft and level of inflammatory cytokines were evaluated by repeated measures analysis of variance. The independent sample t-test was used to compare the differences in age and operation time between the two groups, and the chi-square test was conducted to analyze differences in gender, eye distinction, Tan grade, and postoperative complications.In this analysis, with P <0.05 indicating a statistically significant divergence. 2. Results Throughout the 6-month follow-up, 80 patients underwent LCAG at our institution. Out of these, 74 patients, corresponding to 74 eyes, successfully completed all scheduled follow-up assessments, demonstrating a high rate of compliance among participants. However, it is noteworthy that 6 patients were lost to follow-up, which accounted for a loss rate of 7.50%. Baseline date In this study, 37 patients (37 eyes) were included in each of the two groups. The mean age of group 1 was 68.76±11.07 years, whereas group 2 had a mean age of 67.97±10.10 years. Age was no statistical divergence（ t =-0.31， P =0.751）. Additionally, the differences in gender, surgical eye, and Tan grade were not statistically significant （ χ 2 =0.057， P =0.812； χ 2 =0.055， P =0.815； χ 2 = 0.319， P =0.572）. No notable divergence was observed in the length of the autografts between the two groups (6.23±0.76 mm for group 1 compared to 6.22±0.77 mm for group 2), nor in the width (4.04±0.54 mm for group 1 versus 4.01 ± 0.70 mm for group 2).（t=-0.076， P =0.940； t =-0.185， P =0.854）. Therefore, the two groups were comparable, as shown in Table 2. Table 2 also indicates that the average operation times for groups 1 and 2 were 21.70±5.52 minutes and 27.00±6.09 minutes, respectively. Group 1 exhibited a greater reduction in operative time compared to Group 2( t =-3.921， P <0.001). Table 2. Demographic and clinical data of patients in both groups Demographics Group1 (n=37) Group2 (n=37) P Age(years) 68.76 ± 11.07 67.97 ± 10.10 0.751 Gender (Male/Female) 14/23 15/22 0.812 Surgical eye(Right/Left) 20/17 21/16 0.815 Tan grade(T2/T3) 28/9 30/7 0.572 Operative time(Minutes) 21.70 ± 5.52 27.00 ± 6.09 0.000 The length of the autologous graft(Millimeter) 6.23 ± 0.76 6.22 ± 0.77 0.940 The width of the autologous graft(Millimeter) 4.04 ± 0.54 4.01 ± 0.70 0.854 The thickness of the autograft of patients in group 1 on the 2nd day, 1st week and 1st month postoperatively were 334.14±51.00μm, 765.03±86.78μm, and 202.49±9.34μm, respectively. In comparison, the thickness of the autograft at these same time points for group 2 were 233.14±36.74μm, 885.81±91.01μm, and 200.65±11.83μm. On the 2nd day postoperatively, the thickness of the autograft in Group 1 was found to be greater compared to Group 2( F =95.542, P <0.001). However, this trend reversed by the 1st week postoperatively( F =34.135, P <0.001). On the 1st month postoperatively, there was no statistical divergence( F =0.550, P =0.461). As shown in Figure 3,on the 2nd day, 3rd day and 1st week postoperatively,the VAS scores for patients in group 1 were 2.32±0.60 points, 1.84±0.51 points, and 0.76±0.37 points, respectively. In contrast, the VAS scores for patients in group 2 on the 2nd day, 3rd day, and 1st week postoperatively were 3.05±0.57 points, 2.43±0.49 points, and 1.20±0.47 points. At these various time points, the VAS scores for group 2 were consistently higher than those for group 1 ( F =29.228, 25.732, 19.722; all P <0.001). Compared to the levels of IL-6 and TNF-α on the 2nd day postoperatively, both cytokines were statistically significantly increased in both groups at one week postoperatively (all P <0.001) and decreased by one month postoperatively(all P <0.001). Furthermore, on the 1st week and 1st month postoperatively, their levels in group 1 were lower than those in group 2 (IL-6: F =11.632, 17.503; P =0.001, <0.001; TNF-α: F =4.489, 4.498; P = 0.038, 0.037). Compared to the levels of TGF-β1 on the 2nd day postoperatively, it were statistically significantly increased in both groups at one week postoperatively ( P =0.015) and decreased by one month postoperatively( P =0.009). However, At these various time points,the levels of TGF-β1 was no statistical divergence ( F =2.938, P =0.091; 0.069; 0.468; 0.793; 0.496). By the end of the follow-up period, all patients exhibited varying degrees of corneal scarring. The postoperative complications in group 1 included sub-conjunctival hemorrhage in 12 eyes (32.4%), graft retraction in 12 eyes (32.4%), and graft edema in 7 eyes (18.92%). In group 2, the complications were as follows: sub-conjunctival hemorrhage in 14 eyes (37.8%), graft retraction in 11 eyes (29.7%), and graft edema in 8 eyes (21.6%). There were no statistically significant differences between the two groups regarding sub-conjunctival hemorrhage, graft retraction, and graft edema ( χ 2 =0.237, 0.063, 0.084; P =0.626, 0.802, 0.772). In group 2, only one patient with T3 (2.70%) experienced recurrence; however, since the cornea had not invaded the limbus, no further surgical intervention was necessary. Additionally, no other postoperative complications such as button holing, detachment or displacement of the autograft, granuloma, conjuctival cyst, corneal melt, Scleral perforation occurred in the two groups of patients, as shown in the following table (Table 3). Table 3. Postoperative Complications Postoperative Complications Group1 (n=37) Group2 (n=37) P Corneal scar 37 37 - Subconjunctival hemorrhage 12 14 0.237 Graft retraction 12 11 0.063 Graft edema 7 8 0.084 Recurrence 0 1 - 3. Discussion The primary material of the bandage contact lens is silicone hydrogel. The tight base curve of the lens allows it to conform to the autograft and the sclera, while its high oxygen permeability creates an optimal environment for the growth of the autograft [ 12 , 13 ] . Based on these principles, the bandage contact lens has the potential to serve as a substitute for limbal sutures in LCAG surgery. Consequently, this study introduces, for the first time, a novel method for securing autograft using bandage contact lens and nasal margin suture fixation, a technique that has not been previously reported in the literature. Relevant studies have demonstrated that the average operating time for the traditional suture method during LCAG ranges from 13.30 to 48.15 minutes [ 14 , 15 ] . In our study, the average operation time for Group 2 was 27.00 ± 6.09 minutes, which was significantly shorter (P < 0.001) compared to Group 1, which had an average time of 21.70 ± 5.52 minutes. This reduction in operating time can greatly alleviate discomfort during the procedure. On the 2nd and 3rd days, as well as during the 1st week post-surgery, the VAS scores for group 1 were lower than those for group 2, indicating that patients in group 1 experienced less postoperative pain. Owing to the ability to observe the detailed anatomical structure of the graft, AS-OCT serves as a valuable method for evaluating autograft following pterygium surgery [ 16 ] . This study employed AS-OCT to assess the thickness of the autograft, revealing that the thickness of the autograft was greatest on the 1st week postoperatively, subsequently decreasing and reaching a stable level one month post-operation. On the 2nd days postoperatively, the thickness of autograft in group 1 was significantly greater than that in group 2, likely attributable to the reduced tension from the limbal sutures and a temporary increase in conjunctival edema in group 1. By one week post-surgery, group 2 exhibited a higher degree of edema compared to group 1, which may be associated with the inflammatory response. Previous research have shown that loosened nylon sutures may alter inflammatory factors such as IL-8, IL-1β, and TNF-α, with inflammation subsiding following suture removal [ 17 ] . The initiation and dysregulation of cytokines lead to the formation of conjunctiva-associated lymphoid tissue, thereby eliciting an inflammatory response [ 18 ] . As nylon suture is considered a foreign body and the nasal suture method utilizes fewer sutures than the traditional technique, differences in inflammatory responses between the two methods may arise. Consequently, this study further investigated inflammatory factors. The onset, postoperative healing, and recurrence of pterygium are influenced by a variety of inflammatory factors. Ultraviolet radiation triggers fibroblast activation via TGF-β1 and VEGF, leading to the production of hydrolytic enzymes and growth factors, which promote pterygium formation by remodeling and degrading the extracellular matrix. Postoperative TGF-β overexpression increases the risk of recurrence following surgery. The use of TGF-β receptor inhibitors has been shown to reduce the expression levels of matrix metalloproteinase-1, thereby decreasing the likelihood of pterygium recurrence [ 19 ] . Furthermore, TGF-β1 plays a significant role in conjunctival healing processes [ 20 , 21 ] . This study revealed no significant difference in TGF-β1 levels between the two groups at various postoperative time points, suggesting that the nasal suture technique can create a favorable microenvironment for healing. In comparison to normal corneal conjunctiva, the expression of pro-inflammatory cytokines such as IL-6, IL-8, and TNF is markedly elevated in pterygium tissue [ 22 – 24 ] . The activation of the AKT signaling pathway can down-regulate the transcription of IL-6 and TNF-α, thereby facilitating corneal wound healing [ 25 – 26 ] . The findings indicate that IL-6 and TNF-α levels in group 1 were lower than those in the traditional suture group during the first week and first month post-surgery, which suggests that the nasal margin suture fixation has a milder inflammatory response at these time points. On the 2nd day postoperatively, no significant differences in IL-6 and TNF-α levels were observed between the two groups, which may be attributed to the postoperative administration of tobramycin/dexamethasone eye ointment. A limitation of this study is the small sample size, which could be addressed in future research through an expanded cohort. Additionally, glucocorticoids may mitigate the inflammatory response, potentially influencing the expression levels of IL-6, TNF-α, and TGF-β1, and obscuring differences in inflammatory factor levels between the two groups. Future animal studies and the establishment of a washout period may help eliminate the confounding effects of glucocorticoids. 4. Conclusions In conclusion, the combination of bandage contact lens and nasal margin suture fixation is a safe and effective method for treating pterygium, as it reduces postoperative inflammatory reactions and enhances patient comfort. Declarations Acknowledgements Not applicable. Authors' contributions Xuewei Liu, Xuezhang Zhao and Yuhong Chen were primarily responsible for study design. Xuewei Liu and Jiayu Liu performed data acquisition and analysis, as well as drafting of the manuscript. Can Zheng, Qingdong Liu and Jinshen Liu were also involved in data analysis. All authors reviewed and approved the fnal manuscript. Funding The study was supported by the Genertec Medical Scientific Research Fund(Grant No.TYYLKYJJ-2023-052) and Chengdu Municipal Medical Research Fund(Grant No.2025582). Availability of data and materials Data and materials will be made available on request. Ethics approval and consent to participate This study was approved by the Research Ethics Committee of Cheng Fei Hospital and adhered to the principles outlined in the Declaration of Helsinki (No.2023009).Informed written consent was obtained from all participants. Consent for publication Not applicable. Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Wu KL, He MG,Xu JJ, et al. Pterygium in aged population in Doumen County. Yan Ke Xue Ba o 2002;18:181-184. Zhang L,Lyu RH,Wang JR, et al. Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note. Int J Ophthalmol 2024;17:838-844. Koranyi G,Seregard S,Kopp ED. Cut and paste: a no suture, smaII incision approach to pterygium surgery. Br J OphthaImo I 2004;88:911-914. Bista D,Byanju R,Alexsandronva A, et al. Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery. Nepal J Ophthalmol 2022;13:95-104. Shaaban AM, Elwa. Comparison between sutureless and glue free versus sutured limbal conjunctival autograft in primary pterygium surgery. Saudi J Ophthalmol 2014;28:292-298. Yan B,Peng L,Peng HH, et al. 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Loose suture-related ocular surface inflammation and activation of conjunctiva-associated lymphoid tissue in patients after keratoplasty. Sci Rep 2024;14:10452. Rodolfo M,Luca, A,Vincenzo F, et al. The conjunctiva-associated lymphoid tissue in chronic ocular surface diseases. Microsc Microanal 2017;23:697-707. Cui YH,Feng QY,Liu Q, et al. Posttranscriptional regulation of MMP-9 by HuR contributes to IL-1β-induced pterygium fibroblast migration and invasion. J Cell Physiol 2020;235:5130-5140. Watanabe M,Tsugeno Y,Sato T, et al. TGF-β isoforms affect the planar and subepithelial fibrogenesis of human conjunctival fibroblasts in different manners. Biomedicines 2023;11:2005. Micera A,Puxeddu I,Lambiase A, et al. The pro-fibrogenic effect of nerve growth factor on conjunctival fibroblasts is mediated by transforming growth factor-beta. Clin Exp Allergy 2005;35:650-656. Zidi S,Bediar-Boulaneb F,Belguendouz H, et al. Local pro-inflammatory cytokine and nitric oxide responses are elevated in patients with pterygium. Int J Immunopathol Pharmacol 2017;30:395-405. Feng QY,Hu ZX,Song XL, et al. Aberrant expression of genes and proteins in pterygium and their implications in the pathogenesis. Int J Ophthalmo l 2017;10:973-981. Van ASI,Haagdorens M,Roelant E, et al. Pterygium pathology: a prospective case-control study on tear film cytokine Levels. Mediators Inflamm 2019;2019:9416262. Sun ZW,Lu KP,He Q, et al. INOS ablation promotes corneal wound healing via activation of Akt signaling. Exp Eye Res 2024;243:109886. Guo L,Wang ZH,Zhu CC, et al. MCC950 inhibits the inflammatory response and excessive proliferation of canine corneal stromal cells induced by Staphylococcus pseudintermedius. Mol Immunol 2022;152:162-171. Additional Declarations No competing interests reported. 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Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACfoYDiQ8+8NTIsbE3EKlFsvHAY8MZMseM+XkOEKnF4PDBZ9I8NsyJM2ckEGtL2+EEaZ4ctsQNNx9vvMFQYxNNUAs/z7EEwzlnZIw33E4rtmA4lpbbQNCWGWcSEt72sMluuJ1jJsHYcJiwFoP77z8c4P3HzLjh5hlitRw4kNjIw8OsOHMGD5FaJBsOJDPO4AEFMtAvCcT4BRiV6T8gUXl4440PNTaEtaA4UiKBFOUQLaTqGAWjYBSMgpEBAKdiRslmoj0OAAAAAElFTkSuQmCC","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xuewei","middleName":"","lastName":"Liu","suffix":""},{"id":474815500,"identity":"18a58133-952a-4064-90b4-ccf153bd51a7","order_by":1,"name":"Xuezhang Zhao","email":"","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xuezhang","middleName":"","lastName":"Zhao","suffix":""},{"id":474815503,"identity":"08727236-9b6d-4759-ae2d-bd51d9f72d14","order_by":2,"name":"Yuhong Chen","email":"","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuhong","middleName":"","lastName":"Chen","suffix":""},{"id":474815505,"identity":"54d008f3-17d2-480e-b80c-39e2d674f409","order_by":3,"name":"Can Zheng","email":"","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Can","middleName":"","lastName":"Zheng","suffix":""},{"id":474815507,"identity":"a59c6aa6-1983-4a78-ac50-acb56f697052","order_by":4,"name":"Qingdong Liu","email":"","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qingdong","middleName":"","lastName":"Liu","suffix":""},{"id":474815509,"identity":"b62e2f5c-36ec-4605-a71b-294007bb61ba","order_by":5,"name":"Jiayu Liu","email":"","orcid":"","institution":"Cheng Fei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiayu","middleName":"","lastName":"Liu","suffix":""},{"id":474815510,"identity":"5d01f6cc-3a33-4589-88a7-82613011ed30","order_by":6,"name":"Jinshen Liu","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jinshen","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-06-19 02:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6926634/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6926634/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85618534,"identity":"5749d81a-03a1-4bd1-83b3-5cba15eb5461","added_by":"auto","created_at":"2025-06-29 14:49:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":618395,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical appearance.Bandage contact lens combined with nasal side suture(Group 1): (A) preoperatively, (B) 2nd days postoperative, (C) 1st week postoperative, (D) 2nd weeks postoperative(E) 3rd months postoperative.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraditional interrupted suture (Group 2): (F) preoperative, (G) 2nd days postoperative, (H) 1st week postoperative, (I) 2nd weeks postoperative(J) 3rd month postoperative\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6926634/v1/585b8e2175eaa6321152dda7.png"},{"id":85618480,"identity":"ddc2c32d-0b41-4e99-ae17-1b7b5cc951ec","added_by":"auto","created_at":"2025-06-29 14:49:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":522864,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe thickness of the autologous graft by AS-OCT.Group 1: (A) preoperative, (B) 2nd days postoperative, (C) 1st week postoperative, and (D)1st month postoperative.Group 2: (E) preoperative, (F) 2nd days postoperative, (G) 1st week postoperative, and (H) 1st month postoperative.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6926634/v1/6b55e24edec94762a624c457.png"},{"id":85619358,"identity":"253afbd5-a657-479c-a2a7-5e7e3579b510","added_by":"auto","created_at":"2025-06-29 14:57:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":73284,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe VAS scores (A) , the thickness of the autologous graftand (B) and level of inflammatory cytokines (C-E) at different time points after surgery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6926634/v1/1e0241f4819535e57c4bd2af.png"},{"id":91057761,"identity":"8bd94467-5df2-4a02-a183-f2e93ef9b804","added_by":"auto","created_at":"2025-09-11 08:17:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2479476,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6926634/v1/35471620-8f6d-465a-8e4f-4ac86ec1eb4b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Efficacy of Combined Bandage Contact Lens and Nasal Margin Suture Fixation in Pterygium Patients and Its Impact on Inflammatory Factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePterygium is a common focal fibrovascular proliferation of conjunctival tissue on the cornea, induced by ultraviolet light, with an adult incidence rate ranging from 7\u0026ndash;33%\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It not only affects the cosmetic appearance of the eye but also invades the cornea, causes progressive astigmatism or blocks the pupil area, leading to vision loss and even excessive growth that restricts eye movement. The exact pathogenesis of primary pterygium is complex and remains uncertain, contributing to a high postoperative recurrence rate. With a low recurrence rate and a favorable safety profile, LCAG has emerged as the primary choice for pterygium resection\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Traditional LCAG employs interrupted sutures to secure the autograft; however, the removal of these sutures can lead to pain and bleeding, as well as complications such as infection, inflammation, abscesses, button holes, and prolonged operation time. In 2004, Koranyi et al.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e first proposed the use of adhesive methods for securing autograft.\u003c/p\u003e \u003cp\u003eFibrin glue and autologous serum not only enhance patient comfort but also reduce surgical duration, although they are associated with a higher incidence of complications, including granuloma, detachment or displacement of the autograft compared to suture methods\u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Fibrin glue, derived from human plasma, poses risks of transmitting prion and parvovirus B19 infections, as well as potential postoperative inflammation and allergic reactions. Furthermore, due to its high cost, fibrin glue has not been widely adopted in my country. Related studies have indicated that thermal coagulation may help mitigate detachment or displacement of the autograft\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. However, there are currently limited reports on thermal coagulation, and no standardized protocols exist regarding the energy, duration, and degree of electrocoagulation. Thus, the feasibility and safety of this method is acknowledged.\u003c/p\u003e \u003cp\u003eThe fixation methods for conjunctival autograft have been a subject of debate, primarily due to variations in the stability of autograft, economic costs, surgical duration, and patient comfort. In response to these challenges, we developed a modified surgical technique tailored to clinical needs, which integrates the nasal side sutures with bandage contact lens. This approach retains the nasal side sutures to enhance the stability of the autograft while employing bandage contact lens in place of limbal side sutures, thereby minimizing patient discomfort and streamlining the surgical process. We compared the efficacy and safety of this modified method with the conventional interrupted suture technique in the treatment of primary pterygium.\u003c/p\u003e"},{"header":"1. Patients and methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of Cheng Fei Hospital and adhered to the principles outlined in the Declaration of Helsinki (No.2023009). The sample size necessary for the research was determined using G*power 3.1 software, with an established medium effect size of \u003cem\u003ef\u003c/em\u003e=0.25, a statistical test power of 1-\u003cem\u003e\u0026beta;\u003c/em\u003e=0.9, and a significance level of \u003cem\u003e\u0026alpha;\u003c/em\u003e=0.05\u003csup\u003e[8]\u003c/sup\u003e. The findings suggested that a minimum of 36 subjects was essential for each group.\u003c/p\u003e\n\u003cp\u003eThis prospective study selected 74 patients who underwent LCAG at Cheng Fei Hospital from June 2022 to June 2024, based on established inclusion and exclusion criteria. Participants were categorized into two groups based on the fixation techniques employed for the autograft: Group 1 utilized bandage contact lens combined with nasal side suture, while Group 2 employed traditional interrupted suture. The inclusion criteria were as follows: according to Tan classification\u003csup\u003e[9]\u003c/sup\u003e, the diagnosis of primary nasal pterygium was classified as T2 (moderate) or T3 (severe), and one of the following surgical indicators was met: progressive growth of the pterygium, proximity to the visual axis causing astigmatism, pain or congestion, and limited eye movement\u003csup\u003e[10]\u003c/sup\u003e. The exclusion criteria included: 1) pseud, recurrent, temporal or bilateral pterygium; 2) a history of ocular surface surgery; 3) ocular trauma, ocular inflammation, glaucoma, fundus diseases, or other ophthalmic conditions; 4) severe mental illness, autoimmune diseases, or recent use of immunosuppressive drugs; 5) incomplete data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe conjunctiva was incised 2 to 3 mm outside the corneal limbus, followed by the careful peeling off of the conjunctiva and pterygium. The pterygium was clipped 2 mm before the lacrimal mound to avoid damaging the medial rectus muscle. The head of the pterygium was reversed for examination, and any remaining tissue from the cornea and sclera was excised. Cautery was employed to control bleeding. All procedures were conducted by the same surgeon. A free conjunctival flap containing limbal stem cells, with an incisal margin entering the transparent cornea by 1 mm, was utilized as the graft. The epithelial surface of the graft was placed onto the wound surface of the pterygium. In Group 1:10-0 nylon suture was used to suture the implant and the implant bed at the nasal corner, and bandage contact lens was weared after fully spreading the implant (Figure 1) .In Group 2: Suture the implant with 10-0 nylon thread at the four directions of the implant.Finally, the bandage contact lens was applied (Figure 1). The donor site of the conjunctiva was left unsutured in both groups. Following the removal of the eyelid opener, the patient was instructed to blink to assess the stability of the implant. Then Levofloxacin eye gel (Hubei Grand Pharmaceutical Co., Ltd., approval number: H20150119) was applied, and the eye was bandaged for 48 hours. Levofloxacin eye gel was administered three times daily, and 0.1% tobramycin-dexamethasone eye ointment (S.a.alcon-couvreur N.V, approval number: H20150119) was given four times daily after epithelial repair, with a gradual tapering of doses over the course of one month. Sutures were removed on the 10th days postoperatively and the bandage contact len was removed on the 1st week after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-Up examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent a preoperative examination and regular postoperative follow-up. The operation time, Tan grade, and graft size for each patient were recorded. Additionally, VAS score was used to evaluate the corneal irritation symptoms on the 2nd day, 3rd day and 1st week after operation\u003csup\u003e[11]\u003c/sup\u003e. Anterior segment optical coherence tomography (AS-OCT) (Company: Spectralis Technology, Model: Spectralis OCT) was employed to measure the thickness of the autograft on the 2nd day, 1st week, and 1st month following surgery. A 75 \u0026mu;L glass capillary tube was placed in the lower fornix conjunctival sac of the patient, and siphoning was used to collect tear samples on the 2nd day, 3rd day, and 1st week postoperatively. Then these samples were transferred to a 0.5 ml centrifuge tube and immediately centrifuged and stored at -80\u0026deg;C.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEnzyme-linked immunosorbent assay (ELISA) kits were utilized to detect the concentrations of IL-6, TNF-\u0026alpha;, and TGF-\u0026beta;1. Human ELISA Kits for IL-6 (U96-1510E), TNF-\u0026alpha; (U96-3716E), and TGF-\u0026beta;1 (U96-1114E) were procured from YOBIBIO (Shanghai,China). The specific experimental equipment is as follows in the table (Table 1). Follow-up observations adverse reactions may include transplantation or detachment of graft, persistent nonunion of the graft, infection, conjunctival granuloma, scleral lysis, and corneal pits, among others.\u003c/p\u003e\n\u003cp\u003eTable 1. Experimental Instruments\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompany\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eWater-proof electric heating constant temperat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eShanghai Yuejin Medical Instruments Co., Ltd.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003ePYX-DHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eCentrifuge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eShanghai Anting Scientific Instrument Co., Ltd.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003eTGL-168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eVortex mixer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eShanghai Qingpu Huxi Instrument Factory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003eXW-80A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eElectric thermostaticdrying oven\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eShanghai Jing Hong Laboratory Instrument Co.,Ltd.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003eDHG-9023A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eMicroplate washer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eThermo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003eWellwash 4 MK2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eContinuous dispenser\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eTOMOS LIFE SCIENCE Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003e0.1～50ml\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7755%;\"\u003e\n \u003cp\u003eEnzyme-linked immunosorbent assay instrument\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.8571%;\"\u003e\n \u003cp\u003eThermo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003eDENLEY DRAGON Wellscan MK 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using \u003cem\u003eSPSS\u003c/em\u003e 24.0 statistical software. Counting data were presented either as absolute numbers or percentages, and measuring data that followed a normal distribution were given as mean \u0026plusmn; standard deviation (\u003cimg width=\"43\" height=\"19\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e). The difference of VAS score, thickness of conjunctiva autograft and level of inflammatory cytokines were evaluated by repeated measures analysis of variance. The independent sample \u003cem\u003et-test\u003c/em\u003e was used to compare the differences in age and operation time between the two groups, and the \u003cem\u003echi-square\u003c/em\u003e test was conducted to analyze differences in gender, eye distinction, Tan grade, and postoperative complications.In this analysis, with \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 indicating a statistically significant divergence.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003eThroughout the 6-month follow-up, 80 patients underwent LCAG at our institution. \u0026nbsp;Out of these, 74 patients, corresponding to 74 eyes, successfully completed all scheduled follow-up assessments, demonstrating a high rate of compliance among participants. However, it is noteworthy that 6 patients were lost to follow-up, which accounted for a loss rate of 7.50%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline date\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 37 patients (37 eyes) were included in each of the two groups.\u0026nbsp;The mean age of group 1 was 68.76\u0026plusmn;11.07 years, whereas group 2 had a mean age of 67.97\u0026plusmn;10.10 years. Age was no statistical divergence（\u003cem\u003et\u003c/em\u003e=-0.31，\u003cem\u003eP\u003c/em\u003e=0.751）. Additionally, the differences in gender, surgical eye, and Tan grade were not statistically significant\u0026nbsp;（\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=0.057，\u003cem\u003eP\u003c/em\u003e=0.812；\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=0.055，\u003cem\u003eP\u003c/em\u003e=0.815；\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e= 0.319，\u003cem\u003eP\u003c/em\u003e=0.572）. No notable divergence was observed in the length of the autografts between the two groups (6.23\u0026plusmn;0.76 mm for group 1 compared to 6.22\u0026plusmn;0.77 mm for group 2), nor in the width (4.04\u0026plusmn;0.54 mm for group 1 versus 4.01 \u0026plusmn; 0.70 mm for group 2).（t=-0.076，\u003cem\u003eP\u003c/em\u003e=0.940；\u003cem\u003et\u003c/em\u003e=-0.185，\u003cem\u003eP\u003c/em\u003e=0.854）. Therefore, the two groups were comparable, as shown in Table 2. Table 2 also indicates that the average operation times for groups 1 and 2 were 21.70\u0026plusmn;5.52 minutes and 27.00\u0026plusmn;6.09 minutes, respectively.\u0026nbsp;Group 1 exhibited a greater reduction in operative time compared to Group 2(\u003cem\u003et\u003c/em\u003e=-3.921，\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eTable 2. Demographic and clinical data of patients in both groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup1 (n=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup2 (n=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e68.76 \u0026plusmn; 11.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e67.97 \u0026plusmn; 10.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eGender (Male/Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e14/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e15/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eSurgical eye(Right/Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e20/17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e21/16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eTan grade(T2/T3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e28/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e30/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.572\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eOperative time(Minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e21.70 \u0026plusmn; 5.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e27.00 \u0026plusmn; 6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eThe length of the autologous graft(Millimeter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e6.23 \u0026plusmn; 0.76\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e6.22 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.898%;\"\u003e\n \u003cp\u003eThe width of the autologous graft(Millimeter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4082%;\"\u003e\n \u003cp\u003e4.04 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e4.01 \u0026plusmn; 0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe thickness of the autograft of patients in group 1 on the 2nd day, 1st week and 1st month postoperatively were 334.14\u0026plusmn;51.00\u0026mu;m, 765.03\u0026plusmn;86.78\u0026mu;m, and 202.49\u0026plusmn;9.34\u0026mu;m, respectively. In comparison, the thickness of the autograft at these same time points for group 2 were 233.14\u0026plusmn;36.74\u0026mu;m, 885.81\u0026plusmn;91.01\u0026mu;m, and 200.65\u0026plusmn;11.83\u0026mu;m. On the 2nd day postoperatively, the thickness of the autograft in Group 1 was found to be greater compared to Group 2(\u003cem\u003eF\u003c/em\u003e=95.542, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). However, this trend reversed by the 1st week postoperatively(\u003cem\u003eF\u003c/em\u003e=34.135,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.001). On the 1st month postoperatively, there was no statistical divergence(\u003cem\u003eF\u003c/em\u003e=0.550, \u003cem\u003eP\u003c/em\u003e=0.461).\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 3,on the 2nd day, 3rd day and 1st week postoperatively,the VAS scores for patients in group 1 were 2.32\u0026plusmn;0.60 points, 1.84\u0026plusmn;0.51 points, and 0.76\u0026plusmn;0.37 points, respectively. In contrast, the VAS scores for patients in group 2 on the 2nd day, 3rd day, and 1st week postoperatively were 3.05\u0026plusmn;0.57 points, 2.43\u0026plusmn;0.49 points, and 1.20\u0026plusmn;0.47 points. At these various time points, the VAS scores for group 2 were consistently higher than those for group 1 (\u003cem\u003eF\u003c/em\u003e=29.228, 25.732, 19.722; all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompared to the levels of\u0026nbsp;IL-6 and TNF-\u0026alpha; on the 2nd day postoperatively, both cytokines were statistically significantly increased in both groups at one week postoperatively (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) and decreased by one month postoperatively(all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Furthermore, on the 1st week and 1st month postoperatively, their levels in group 1 were lower than those in group 2 (IL-6:\u003cem\u003eF\u003c/em\u003e=11.632, 17.503; \u003cem\u003eP\u003c/em\u003e=0.001, \u0026lt;0.001; TNF-\u0026alpha;:\u003cem\u003eF\u003c/em\u003e=4.489, 4.498;\u003cem\u003e\u0026nbsp;P\u003c/em\u003e = 0.038, 0.037). Compared to the levels of TGF-\u0026beta;1 on the 2nd day postoperatively, it were statistically significantly increased in both groups at one week postoperatively (\u003cem\u003eP\u003c/em\u003e=0.015) and decreased by one month postoperatively(\u003cem\u003eP\u003c/em\u003e=0.009). However, At these various time points,the levels of TGF-\u0026beta;1 was no statistical divergence (\u003cem\u003eF\u003c/em\u003e=2.938, \u003cem\u003eP\u003c/em\u003e=0.091; 0.069; 0.468; 0.793; 0.496).\u003c/p\u003e\n\u003cp\u003eBy the end of the follow-up period, all patients exhibited varying degrees of corneal scarring. The postoperative complications in group 1 included sub-conjunctival hemorrhage in 12 eyes (32.4%), graft retraction in 12 eyes (32.4%), and graft edema in 7 eyes (18.92%). In group 2, the complications were as follows: sub-conjunctival hemorrhage in 14 eyes (37.8%), graft retraction in 11 eyes (29.7%), and graft edema in 8 eyes (21.6%). There were no statistically significant differences between the two groups regarding sub-conjunctival hemorrhage, graft retraction, and graft edema (\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=0.237, 0.063, 0.084; \u003cem\u003eP\u003c/em\u003e=0.626, 0.802, 0.772). In group 2, only one patient with T3 (2.70%) experienced recurrence; however, since the cornea had not invaded the limbus, no further surgical intervention was necessary. Additionally, no\u0026nbsp;other postoperative complications such as button holing, detachment or displacement of the autograft, granuloma, conjuctival cyst, corneal melt, Scleral perforation occurred in the two groups of patients, as shown in the following table (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. Postoperative Complications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup1 (n=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup2 (n=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003eCorneal scar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003eSubconjunctival hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003eGraft retraction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003eGraft edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2062%;\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.6804%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThe primary material of the bandage contact lens is silicone hydrogel. The tight base curve of the lens allows it to conform to the autograft and the sclera, while its high oxygen permeability creates an optimal environment for the growth of the autograft \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Based on these principles, the bandage contact lens has the potential to serve as a substitute for limbal sutures in LCAG surgery. Consequently, this study introduces, for the first time, a novel method for securing autograft using bandage contact lens and nasal margin suture fixation, a technique that has not been previously reported in the literature.\u003c/p\u003e \u003cp\u003eRelevant studies have demonstrated that the average operating time for the traditional suture method during LCAG ranges from 13.30 to 48.15 minutes\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In our study, the average operation time for Group 2 was 27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09 minutes, which was significantly shorter (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to Group 1, which had an average time of 21.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52 minutes. This reduction in operating time can greatly alleviate discomfort during the procedure.\u003c/p\u003e \u003cp\u003eOn the 2nd and 3rd days, as well as during the 1st week post-surgery, the VAS scores for group 1 were lower than those for group 2, indicating that patients in group 1 experienced less postoperative pain. Owing to the ability to observe the detailed anatomical structure of the graft, AS-OCT serves as a valuable method for evaluating autograft following pterygium surgery\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This study employed AS-OCT to assess the thickness of the autograft, revealing that the thickness of the autograft was greatest on the 1st week postoperatively, subsequently decreasing and reaching a stable level one month post-operation. On the 2nd days postoperatively, the thickness of autograft in group 1 was significantly greater than that in group 2, likely attributable to the reduced tension from the limbal sutures and a temporary increase in conjunctival edema in group 1. By one week post-surgery, group 2 exhibited a higher degree of edema compared to group 1, which may be associated with the inflammatory response. Previous research have shown that loosened nylon sutures may alter inflammatory factors such as IL-8, IL-1β, and TNF-α, with inflammation subsiding following suture removal \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The initiation and dysregulation of cytokines lead to the formation of conjunctiva-associated lymphoid tissue, thereby eliciting an inflammatory response \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. As nylon suture is considered a foreign body and the nasal suture method utilizes fewer sutures than the traditional technique, differences in inflammatory responses between the two methods may arise. Consequently, this study further investigated inflammatory factors. The onset, postoperative healing, and recurrence of pterygium are influenced by a variety of inflammatory factors. Ultraviolet radiation triggers fibroblast activation via TGF-β1 and VEGF, leading to the production of hydrolytic enzymes and growth factors, which promote pterygium formation by remodeling and degrading the extracellular matrix.\u003c/p\u003e \u003cp\u003ePostoperative TGF-β overexpression increases the risk of recurrence following surgery. The use of TGF-β receptor inhibitors has been shown to reduce the expression levels of matrix metalloproteinase-1, thereby decreasing the likelihood of pterygium recurrence\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Furthermore, TGF-β1 plays a significant role in conjunctival healing processes \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This study revealed no significant difference in TGF-β1 levels between the two groups at various postoperative time points, suggesting that the nasal suture technique can create a favorable microenvironment for healing. In comparison to normal corneal conjunctiva, the expression of pro-inflammatory cytokines such as IL-6, IL-8, and TNF is markedly elevated in pterygium tissue \u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The activation of the AKT signaling pathway can down-regulate the transcription of IL-6 and TNF-α, thereby facilitating corneal wound healing \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The findings indicate that IL-6 and TNF-α levels in group 1 were lower than those in the traditional suture group during the first week and first month post-surgery, which suggests that the nasal margin suture fixation has a milder inflammatory response at these time points. On the 2nd day postoperatively, no significant differences in IL-6 and TNF-α levels were observed between the two groups, which may be attributed to the postoperative administration of tobramycin/dexamethasone eye ointment.\u003c/p\u003e \u003cp\u003eA limitation of this study is the small sample size, which could be addressed in future research through an expanded cohort. Additionally, glucocorticoids may mitigate the inflammatory response, potentially influencing the expression levels of IL-6, TNF-α, and TGF-β1, and obscuring differences in inflammatory factor levels between the two groups. Future animal studies and the establishment of a washout period may help eliminate the confounding effects of glucocorticoids.\u003c/p\u003e"},{"header":"4. Conclusions","content":"\u003cp\u003eIn conclusion, the combination of bandage contact lens and nasal margin suture fixation is a safe and effective method for treating pterygium, as it reduces postoperative inflammatory reactions and enhances patient comfort.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXuewei Liu, Xuezhang Zhao and Yuhong Chen were primarily responsible for study design. Xuewei Liu and Jiayu Liu performed data acquisition and analysis, as well as drafting of the manuscript. Can Zheng, Qingdong Liu and Jinshen Liu were also involved in data analysis. All authors reviewed and approved the fnal manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by the Genertec Medical Scientific Research Fund(Grant No.TYYLKYJJ-2023-052) and Chengdu Municipal Medical Research Fund(Grant No.2025582).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials will be made available on request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of Cheng Fei Hospital and adhered to the principles outlined in the Declaration of Helsinki (No.2023009).Informed written consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu KL, He MG,Xu JJ, et al. Pterygium in aged population in Doumen County. \u003cem\u003eYan Ke Xue Ba\u003c/em\u003eo 2002;18:181-184.\u003c/li\u003e\n\u003cli\u003eZhang L,Lyu RH,Wang JR, et al. Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note. \u003cem\u003eInt J Ophthalmol\u003c/em\u003e 2024;17:838-844.\u003c/li\u003e\n\u003cli\u003eKoranyi G,Seregard S,Kopp ED. Cut and paste: a no suture, smaII incision approach to pterygium surgery.\u003cem\u003e Br J OphthaImo\u003c/em\u003eI 2004;88:911-914.\u003c/li\u003e\n\u003cli\u003eBista D,Byanju R,Alexsandronva A, et al. Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery. \u003cem\u003eNepal J Ophthalmol\u003c/em\u003e 2022;13:95-104.\u003c/li\u003e\n\u003cli\u003eShaaban AM, Elwa. 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Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision.\u003cem\u003e Arch Ophthalmol\u003c/em\u003e 1997;115:1235-1240.\u003c/li\u003e\n\u003cli\u003eGraue-Hernandez EO,C\u0026oacute;rdoba A,Jimenez-Corona A, et al. Practice Patterns in the Management of Primary Pterygium: A Survey Study. \u003cem\u003eCornea \u003c/em\u003e2019;38:1339-1344.\u003c/li\u003e\n\u003cli\u003eHe S,Rrnne A,Argandykov D, et al. Comparison of an Emoji-Based Visual Analog Scale With a Numeric Rating Scale for Pain Assessment. JAMA 2022;328:208-209.\u003c/li\u003e\n\u003cli\u003eSharma N,Sah R,Priyadarshini K, et al. Contact lenses for the treatment of ocular surface diseases.\u003cem\u003e Indian J Ophthalmo\u003c/em\u003el 2023;71:1135-1141.\u003c/li\u003e\n\u003cli\u003eHirabayashi KE,S\u0026aacute;les C,Slade SG, et al. Prospective, randomized, eye-to-eye comparison of a new silicone corneal shield versus conventional bandage contact lens after photorefractive keratectomy.\u003cem\u003e J Cataract Refract Surg \u003c/em\u003e2019;45:1782-1788.\u003c/li\u003e\n\u003cli\u003eHamidi AD, Mohamad-Reza S, Reza A, et al. Comparison of autologous fibrin glue versus nylon sutures for securing conjunctival autografting in pterygium surgery. \u003cem\u003eInt Ophthalmol\u003c/em\u003e 2018;38,1219-1224.\u003c/li\u003e\n\u003cli\u003eHuang HX,Li SQ,Zhong J, et al. Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium.\u003cem\u003e Cornea \u003c/em\u003e2020;39:1581-1587.\u003c/li\u003e\n\u003cli\u003eSon JH,Lim SH. 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Local pro-inflammatory cytokine and nitric oxide responses are elevated in patients with pterygium. \u003cem\u003eInt J Immunopathol Pharmacol\u003c/em\u003e 2017;30:395-405.\u003c/li\u003e\n\u003cli\u003eFeng QY,Hu ZX,Song XL, et al. Aberrant expression of genes and proteins in pterygium and their implications in the pathogenesis. \u003cem\u003eInt J Ophthalmo\u003c/em\u003el 2017;10:973-981.\u003c/li\u003e\n\u003cli\u003eVan ASI,Haagdorens M,Roelant E, et al. Pterygium pathology: a prospective case-control study on tear film cytokine Levels. \u003cem\u003eMediators Inflamm \u003c/em\u003e2019;2019:9416262.\u003c/li\u003e\n\u003cli\u003eSun ZW,Lu KP,He Q, et al. INOS ablation promotes corneal wound healing via activation of Akt signaling. \u003cem\u003eExp Eye Res\u003c/em\u003e 2024;243:109886.\u003c/li\u003e\n\u003cli\u003eGuo L,Wang ZH,Zhu CC, et al. MCC950 inhibits the inflammatory response and excessive proliferation of canine corneal stromal cells induced by Staphylococcus pseudintermedius.\u003cem\u003e Mol Immunol\u003c/em\u003e 2022;152:162-171.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pterygium, Conjunctival autograft, Complication, Inflammatory factors","lastPublishedDoi":"10.21203/rs.3.rs-6926634/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6926634/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo evaluate the efficacy of the combination of bandage contact lens and nasal margin suture fixation in pterygium resection, specifically examining the effects on IL-6, TNF-α, and TGF-β1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis prospective research involved the selection of 74 patients who received limbal conjunctival autograft (LCAG) procedures at Cheng Fei Hospital between June 2022 and June 2024. Participants were categorized into two groups based on the fixation techniques employed for the autograft. Group 1 utilized bandage contact lens combined with nasal side suture, while Group 2 employed traditional interrupted suture. All patients underwent a preoperative examination and regular postoperative follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eGroup 1 exhibited a greater reduction in operative time compared to Group 2(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). On the 2nd day postoperatively, the thickness of the autograft in Group 1 was found to be greater compared to Group 2 (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). However, this trend reversed by the 1st week postoperatively(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). On the 1st month postoperatively, there was no statistical divergence(\u003cem\u003eP\u003c/em\u003e=0.461).On the 2nd day, 3rd day and 1st week postoperatively, the Visual Analog Scale (VAS) scores for group 2 were consistently higher than those for group 1 (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Compared with the levels of IL-6, TNF-α, and TGF-β1 on the 2nd day postoperatively, all cytokines were statistically significantly increased in both groups at one week postoperatively (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) and decreased by one month postoperatively(all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Furthermore, on the 1st week and 1st month postoperatively, the levels of IL-6 and TNF-α in group 1 were lower than those in group 2 (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).However, At these various time points,the levels of TGF-β1 was no statistical divergence(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).Regarding postoperative complications, including corneal scar,sub-conjunctival hemorrhage, graft retraction, graft edema and recurrence, no significant differences were observed between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe combination of bandage contact lens and nasal margin suture fixation is a safe and effective method for treating pterygium, as it reduces postoperative inflammatory reactions and enhances patient comfort.\u003c/p\u003e","manuscriptTitle":"The Efficacy of Combined Bandage Contact Lens and Nasal Margin Suture Fixation in Pterygium Patients and Its Impact on Inflammatory Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-29 14:49:46","doi":"10.21203/rs.3.rs-6926634/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"50b7e50b-7620-417e-8240-83d429c180bd","owner":[],"postedDate":"June 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T08:09:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-29 14:49:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6926634","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6926634","identity":"rs-6926634","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}