Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting

Abstract

Purpose:The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue.Methods:In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema.Results:The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded.Conclusion:Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium.

Pterygium excision with suture free, glue free conjunctival autograft: is it the ideal procedure for primary pterygium

“…Graft edema was a common complication 45 patients (86.53%) in our study while in a study by Shreesha kumar 9 graft edema was observed in 52.04%. Graft edema completely subsided at the 7 th day follow up.…”

Pterygium Recurrence Rates in the Hispanic Population in the Northeastern United States

“…Currently, conjunctival autograft is the gold standard. 12 13 In other countries, alternate methods of pterygium excision are still used, however, these methods are associated with increased recurrence. 14 15 …”

Pterygium Excision and Conjunctival Graft from the Pterygium Tissue Itself without Rotation

“…[6] A recent study though suggested that rotation of the conjunctival sheet had no significance on the outcome with the recurrence rates just as comparable. [2] Our technique was similar, where the underlying pterygium tissue was removed and the original epithelium was placed over the bare sclera without any rotation. In comparison to CAG, obtaining the graft from the pterygium tissue itself was more challenging, in view of procuring an appropriately sized graft and with regards to its fragility.…”

“…[4] However, the graft may not be enough to cover the bare scleral defect in double-headed pterygiums, nor is it advisable in glaucoma suspect cases for future trabulectomy management. [2] In such indications, an unconventional approach suggested the use of conjunctival tissue from the pterygium itself to cover the bare scleral defect with 180° rotation of the graft. [6] In this study, we employ a modified technique of using conjunctival graft from the pterygium tissue itself without any rotation with fibrin glue.…”