J Korean Ophthalmol Soc.  2010 May;51(5):642-650.

Clinical Research on Surgical Treatment for Double-Head Pterygium

• Lee BH
• Lee GJ
• Park YJ
• Lee KW

Abstract

PURPOSE
To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate.
METHODS
In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications.
RESULTS
Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.9+/-3.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.2+/-1.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.6+/-2.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site.
CONCLUSIONS
In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.

Keyword

Amniotic membrane transplantation; Double-head pterygium; Split-conjunctival grafts

MeSH Terms

Amnion
Cosmetics
Eye
Follow-Up Studies
Humans
Membranes
Pterygium
Recurrence
Tissue Donors
Transplants
Cosmetics

Figure

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  Figure 1. Surgical procedure of split-conjunctival grafts for double-head pterygium. (A) The temporal and nasal side pterygium is along with adjacent fibrovascular tissue. (B, C) Conjunctival graft (6 mm) is dissected from the fornix leaving the underlying Tenon's capsule intact, flipped over the cornea. (D, E) From the donor conjunctiva, the distal 3 mm is excised and attached to the temporal bare sclera area using tissue adhesives. (F, G, H) The remaining graft is excised all the way down to the limbus, and attached to the nasal bare sclera area using tissue adhesives. (I) To protect and stabilize the conjunctiva autograft, temporary amniotic membrane transplantation is applied onto the whole eye with 10–0 nylon suture left in place for 5∼7 days.

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  Figure 2. Pre and postoperative photographs for amniotic membrane transplantation group. (A, B1) Preoperative photograghs of double-head pterygium. (A, B2) The transplanted amniotic membrane seems to blend in with stable ocular surface at 3 months postoperatively. (A3) Conjunctival recurrence at 5 months postoperatively. (B3, B4) Shows corneal recurrence at 9 months postoperatively, and the following stabilization after limbal-conjunctival autograft.

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  Figure 3. Pre and postoperative photogragh for split-conjunctival grafts group. (A, B1) Preoperative photograghs of double-head pterygium. (A, B2) Well-positioned graft and quiet conjunctival surface are observed in subjects at 1 month postoperatively. (A, B3) Normal appearance is seen and recurrence of pterygium is not recognized in subjects at 12 months postoperatively.

Reference

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