J Korean Ophthalmol Soc.  2008 Feb;49(2):205-212. 10.3341/jkos.2008.49.2.205.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

• Kwak DY
• Bae MC
• Lee JK
• Park DJ

• KMID: 2127110
• DOI: http://doi.org/10.3341/jkos.2008.49.2.205

Abstract

PURPOSE: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia.
METHODS
Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated.
RESULTS
With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group.
CONCLUSIONS
Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.

Keyword

Conjunctivo-limbal autograft; Pterygium; Recurrence rates

MeSH Terms

Cornea
Cosmetics
Eye
Fibrosis
Follow-Up Studies
Granuloma
Hemorrhage
Humans
Pterygium
Recurrence
Tenon Capsule
Tissue Donors
Cosmetics

Figure

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  Figure 1. Classification of pterygium. (A) Grade T1 (atrophic) episcleral vessels are unobscured. (B) Grade T2 (intermediate) episcleral vessels are partially obscured. (C) Grade T3 (fleshy) episcleral vessels are totally obscured.

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  Figure 2. Photographs illustrating the surgical technique of conjunctivo-limbal autograft. (A) excision and blunt dissection of pterygium from the cornea and sclera by using conjunctival scissors. (B) remnant pterygium of the cornea was dissected off by corneal forceps. (C) wide excision of subconjunctival Tenon's tissue was done by the Ellman cautery. (D) the donor site was marked with a gentian violet. (E-F) conjunctival graft is dissected with conjunctival scissors leaving the underlying Tenon's capsule intact. (G) the limbus is dissected with No. 64 Beaver blade. (H) the conjunctivo-limbal graft is transferred and secured with multiple interrupted sutures. (I) triamcinolon was injected

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  Figure 3. Grading of recurrence after pterygium surgery. (A) Grade 0, normal appearance of the operated site. (B) Grade 1, fine episcleral vessels in the excised area (C) Grade 2, fibrovascular tissue in the excised area, reaching to the limbus, but not invading the cornea (conjunctival recurrence). (D) Grade 3, fibrovascular tissue invading the cornea (corneal recurrence)

• 

  Figure 4. (A) The left eye before surgery has a large and fleshy recurrent pterygium. (B-C) At 2 days after surgery. The well anchored conjunctivo-limbal autograft was seen B. Note epithelial defect at donor site under fluorescein staining C. (D-E) At 3 weeks after surgery. The surgical wound is healed D and complete epithelization at donor site under fluorescein staining is seen E. (F-G) At 6 months after surgery. Normal appearance (Grade 0) is seen F and there is no scarring or excessive vascularization at donor site G.

• 

  Figure 5. Postoperative complications. (A) Sub-graft hemorrhage. (B) Graft edema. (C) Excessive vascularization at donor site. (D) Wound dehiscence at early postoperative period (arrowhead).

Reference

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