title: Cosmesis after pterygium extended removal followed by extended conjunctival transplant as assessed by a new, web-based grading system.
abstract: OBJECTIVE
  To design a web-based system to grade the cosmetic results after pterygium surgery and to use this to assess the aesthetic results of pterygium extended removal followed by extended conjunctival transplant.
  
  
  METHODS
  A standardized grading system with gradings of normal, excellent, good, fair, poor, and ungradeable was designed and tested by the author (standard gradings). This was then installed on a website where ophthalmologists and lay people could undertake grading and anatomy tutorials, and subsequently grade randomly assigned images in a masked fashion, of eyes after pterygium surgery and control eyes.
  
  
  METHODS
  A sample of 119 postoperative eyes were randomly selected from 279 consecutive surgeries together with 119 control eyes from the contralateral eyes of these patients supplemented with otherwise normal eyes.
  
  
  METHODS
  The author was tested twice on a sample of 40 images and then the full set, with 24 images repeated giving a total of 288 images using the proposed grading system, resulting in an intraobserver reliability score of 0.98. These images were then randomly presented to the graders, of whom 6 were postpterygium patients and 6 were corneal specialist ophthalmologists after they had completed the tutorials and passed a trial grading test.
  
  
  METHODS
  The percentage of images of postoperative and controls that were graded in each grading category were obtained and compared with the only existent study of post pterygium cosmetic results.
  
  
  RESULTS
  Six lay people and 6 corneal specialists successfully passed the trial grading test of 40 images with weighted kappa of 0.70 to 0.85 and intraobserver reliability scores of 0.86 to 0.95 for lay graders and 0.90 to 0.92 for ophthalmic graders. Ninety-four percent of all pterygium surgery eyes were graded as acceptable; both ophthalmic and lay graders were unable to distinguish between postoperative and control eyes.
  
  
  CONCLUSIONS
  This grading system is robust and user friendly, and pterygium extended removal followed by extended conjunctival transplant provides a very pleasing aesthetic result in most patients.
authors.affiliation: Queensland Eye Institute, the University of Queensland, and The Australian Pterygium Centre, Brisbane, Australia. lawrie@tapc.net.au
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Hirst
mesh_terms: D000328:Adult; D003228:Conjunctiva / Q000637:transplantation*; D004954:Esthetics / Q000145:classification*; D005260:Female; D006801:Humans; D020407:Internet / Q000145:classification; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D010781:Photography; D011184:Postoperative Period; D011625:Pterygium / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome