Conjunctival graft from pterygium tissue itself in primary pterygium surgery
Abstract
Background: The aim of a study was to assess the efficacy of a new surgical technique that uses conjunctival tissuefrom the pterygium itself as a graft with a 180-degree rotation and fibrin glue in the primary pterygium surgery.
Material and methods: For this non-comparative, interventional study, 36 eyes from 36 patients with primary pterygium were operated on between January 2019 and December 2019. Pterygium was used to create a thin conjunctival graft (CAG) layer in this technique. This pterygium layer was entirely separated from the underlying fibrovascular tissue and retained on the corneal surface. A thin conjunctival graft was transferred to the bare sclera bed with the epithelial side up and rotated 180° before adhering to the bare sclera bed with fibrin glue. The primary outcome was the recurrence of pterygium. Other secondary variables included graft edema and graft retraction.
Results: The primary outcome was the recurrence of pterygium. Graft edema and graft retraction were considered as other complications. The average age was 47.5 years, with an 8-month follow-up. According to the study, the patients had an 8.3% recurrence rate (3 eyes out of 36). Graft edema was the only significant complication (52.77%, 19 eyes out of 36), which resolved without intervention. Graft retraction was the second most common complication, accounting for 27.7% of all cases (10 eyes out of 36).
Conclusion: In this technique, there is no tissue wastage (as in excision), no trauma to the normal area (as in conjunctival autograft), no suture-related complications, and shorter operating time. This technique can be used as a safe and alternative to CAG for patients in whom CAG cannot be performed with very low recurrence rates and complications.
Keywords: conjunctivapterygiumautograftfibrin gluepterygium recurrence
References
- Demartini DR, Vastine DW. Pterygium. Surgical interventions Corneal and External diseases. Grune and Straton, Orlando 1987: 141.
- Asokan R, Venkatasubbu RS, Velumuri L, et al. Prevalence and associated factors for pterygium and pinguecula in a South Indian population. Ophthalmic Physiol Opt. 2012; 32(1): 39–44.
- Nangia V, Jonas JB, Nair D, et al. Prevalence and associated factors for pterygium in rural agrarian central India. The central India eye and medical study. PLoS One. 2013; 8(12): e82439.
- Moran DJ, Hollows FC. Pterygium and ultraviolet radiation: a positive correlation. Br J Ophthalmol. 1984; 68(5): 343–346.
- Sencer WH. Ohthalmic Pathology: An Atlas and Textbook. Vol. 1 3rd ed. WB Saunders, Philadelphia 1985: 174–176.
- Di Girolamo N, Chui J, Coroneo MT, et al. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res. 2004; 23(2): 195–228.
- Ang LPK, Chua JLL, Tan DTH. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol. 2007; 18(4): 308–313.
- Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985; 92(11): 1461–1470.
- Sune MP, Sune PG. Conjunctival Rotation Autograft for Pterygium: An Alternative to Conventional Conjunctival Autografting. Asia Pac J Ophthalmol (Phila). 2013; 2(4): 227–231.
- Jap A, Chan C, Lim L, et al. Conjunctival rotation autograft for pterygium. An alternative to conjunctival autografting. Ophthalmology. 1999; 106(1): 67–71.
- Luthra R, Nemesure BB, Wu SY, et al. Barbados Eye Studies Group. Frequency and risk factors for pterygium in the Barbados Eye Study. Arch Ophthalmol. 2001; 119(12): 1827–1832.
- Dupps WJ, Jeng BH, Meisler DM. Narrow-strip conjunctival autograft for treatment of pterygium. Ophthalmology. 2007; 114(2): 227–231.
- Rao SK, Lekha T, Mukesh BN, et al. Conjunctival-limbal autografts for primary and recurrent pterygia: technique and results. Indian J Ophthalmol. 1998; 46(4): 203–209.
- Sharma AK, Kumar VB. Rotational grafting of pterygium. Indian J Ophthalmol. 1984; 32(3): 149–151.
- Hirst LW. Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: recurrence rate and cosmesis. Ophthalmology. 2009; 116(7): 1278–1286.
- Liang W, Li R, Deng X. Comparison of the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation . Eye Sci. 2012; 27(2): 102–105.
- Moriarty AP, Crawford GJ, McAllister IL, et al. Severe corneoscleral infection. A complication of beta irradiation scleral necrosis following pterygium excision. Arch Ophthalmol. 1993; 111(7): 947–951.
- Chen PP, Ariyasu RG, Kaza V, et al. A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol. 1995; 120(2): 151–160.
- Karalezli A, Kucukerdonmez C, Akova YA, et al. Does topical bevacizumab prevent postoperative recurrence after pterygium surgery with conjunctival autografting? Int J Ophthalmol. 2014; 7(3): 512–516.
- Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985; 92(11): 1461–1470.
- Mutlu FM, Sobaci G, Tatar T, et al. A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology. 1999; 106(4): 817–821.
- Tan D. Conjunctival grafting for ocular surface disease. Curr Opin Ophthalmol. 1999; 10(4): 277–281.
- P. RD, C KA. Pterygium excision with conjunctival autograft with autologous blood. Indian J Clin Experiment Ophthalmol. 2020; 4(4): 548–550.
- Maheshwari S, Maheshwari S. Split-conjunctival grafts for double-head pterygium. Indian J Ophthalmol. 2005; 53(1): 53–55.
- Wu WK, Wong VWY, Chi SCC, et al. Surgical management of double-head pterygium by using a novel technique: conjunctival rotational autograft combined with conjunctival autograft. Cornea. 2007; 26(9): 1056–1059.