Outcome of Inferonasal Conjunctival Autograft in Pterygium Surgery

This study was done to evaluate the outcome of pterygium excision with inferonasal conjunctival autograft at a tertiary eye care centre. Retrospective analysis of medical records of primary pterygia patients operated by a single surgeon between 2017 to 2020 were analyzed. A total of 43 patients who met the inclusion criteria were included in the study. The demographic variables, along with size of pterygium and recurrence over a period of six month follow up was noted. The mean age of patients was 46.97 years (29-74 years). The mean size of pterygium was 3.17 mm. Recurrence was seen in 3 eyes over a period of 6 months. Graft edema was observed in 11 patients and graft hemorrhage along with congestion was seen in 8 cases which resolved over a 3 weeks follow up period. Mild conjunctival scarring was seen over donor area in 5 of the eyes. Pterygium excision with inferior conjunctival autograft is an effective alternative technique to superotemporal autograft technique.

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.

Scedosporium scleritis following pterygium excision with conjunctival autograft

A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery

Background The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration. Material and Methods This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017. Results The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 – 7) minutes in group 1 and 8.23 ± 1.26 (8 – 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001). Conclusions The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

Pterygium surgery using a conjunctival autograft

Surgery is the only effective treatment for pterygium. The most common technique is the use of a conjunctival autograft after excision of the pterygium. However, the frequency of recurrences of this method, as well as possible complications in different sources, are different. Purpose. To evaluate the efficacy, safety and recurrence rate of conjunctival autograft after pterygium excision. Material and methods. 101 patients with pterygium. aged 57.31 ± 14.7 years. The follow-up period was 1 year in 56 patients and 2 years in 45 patients. All patients underwent excision of the pterygium with conjunctival autograft. Results. An intraoperative complication can be attributed to the insufficient area of the autoconjunctival graft during its transfer to the sclera, which occurred in three patients. Postoperative complications: graft edema in 14 cases (13.86%), granuloma in the suture area was observed in 1 case (0.99%). Recurrence of pterygium was noted in only three cases (2.97%). Conclusion. The use of a conjunctival autograft in pterygium surgery has shown its effectiveness and safety, as well as a low recurrence rate. The donor zone in the upper and lateral makes it possible to excise a sufficient area of autoconjunctival graft with preservation of the intact area of possible future surgery for glaucoma. Key words: conjunctival autograft, pterygium, recurrence of pterygium.

Evaluation of the recurrence rate and complications for pterygium treated with limbal conjunctival autograft

AIM: To evaluate the safety and efficacy of limbal conjunctival autograft transplantation for treating primary pterygium over a period of 3y. METHODS: Prospective observational consecutive case series. In this study, 264 eyes of 264 patients (142 males and 122 females) with nasal primary pterygium were treated using the technique of limbal conjunctival autograft. The mean ages of the patients were 54.22±15.24y. After excision of the pterygium patients were followed up on 1, 3, 7d and at 1, 3, 6, 9, 12, and 36mo. Recurrence of pterygium, complications, operation time and corneal epithelialization time were evaluated. RESULTS: The average surgery time was 25.7±2.6min. With a minimum 3-year of follow-up, postoperative corneal epithelialization was completed in 3.85±0.72d. Complications were observed in 14 cases. Vision-threating complications such as iritis, scleral thinning symblepharon or ulceration were not detected in the study. Five eyes with graft edema, 3 eyes with granuloma formation and 6 cases with a subconjunctival hematoma in the nasal conjunctiva. By the end of 3-year follow-up, recurrence was detected in 11 cases. The recurrence rate was 4.17%, and the onset of recurrence was 3mo, the average recurrence time was 8mo. CONCLUSION: There were no severe complications and few recurrences when limbal conjunctival autograft transplantation was performed after long-term follow-up, we suggest that limbal conjunctival autograft transplantation is a safe and effective technique in primary pterygium. We also recommend that 12-month follow-up is optimal on primary pterygium surgery.

Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

Clinical Outcome of Fibrin Glue versus Sutures in Conjunctival Autografts in Patients Undergoing Pterygium Excision - A Prospective Study from Kalaburagi, Karnataka

BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - < 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - > 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue

Sutureless Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery

Introduction: Surgical excision is the definitive treatment for pterygium. Following excision, conjunctival autograft is usually preferred. Various methods for grafting with sutures, glue or autologous serum from the recipient bed are in use. The objective of this study was to compare surgical outcomes of sutureless glue free conjunctival autograft with sutured (vicryl 8-0) conjunctival autograft in primary pterygium excision. Materials and methods: A prospective randomized interventional study was carried out in 100 eyes with primary pterygium. They were divided into two groups for conjunctival graft adhesion; sutureless glue free (group 1; n=50 eyes) and sutured with absorbable (vicryl 8-0) suture (group 2; n=50 eyes). Time taken for surgery, complications, postoperative symptoms and overall satisfaction score were noted. The patients were followed up on day 1, day 14 and 6 weeks after surgery. Recurrence was noted till 1 year after surgery. Results: The mean age was 46.76 ± 11.97 years (group 1) and 47.24±12.76 years (group 2). Group 1 had shorter duration of surgery (p<0.001), less postoperative complaints (p<0.001) and better patient satisfaction (p<0.001) than group 2. Postoperative complications and gain in visual acuity in both the groups were not clinically significant. Recurrence was not significant in both groups until 1 year of follow up. Conclusion: Pterygium surgery with sutureless glue free conjunctival autograft had fewer postoperative complaints and better patient satisfaction than pterygium surgery with sutured conjunctival autograft. The postoperative complications, recurrence were comparable to conventional sutured technique.