USE OF SUPERO-TEMPORAL FREE CONJUNCTIVO–LIMBAL AUTOGRAFT IN THE SURGICAL MANAGEMENT OF PTERYGIUM: OUR TECHNIQUE AND RESULTS
AbstractBackground: A pterygium is a fibro-vascular, wing shaped encroachment of the conjunctiva on to thecornea. The prevalence rates ranges from 0.7 to 31% among different populations and also influencedby age, race, and exposure to solar radiations. Ultraviolet light-induced damage to the limbal stem cellbarrier with subsequent conjunctivalisation of the cornea is the currently accepted aetiology of thiscondition. Indication of surgery include visual impairment, cosmetic disfigurement, motility restriction,recurrent inflammation and interference with contact lens wear. This Study was conducted to know thesafety, efficacy and success with supero-temporal free conjunctivo-limbal auto graft transplantation inthe surgical management of pterygium. Methods: Prospective case series where supero temporal freeconjunctivo-limbal auto grafting was performed on 72 eyes of 72 patients with vascular progressivepterygia. Pterygium recurrence was considered a surgical failure. Recurrence was defined as fibrovascular tissue crossing the corneo-scleral limbus on to the clear cornea in the area of previouspterygium excision before 6 months. Results: Recurrence of pterygium was noted in three out of 72eyes (4.16%), after a minimum follow up of 12 months to maximum of 25 months (Mean 14.6months). No major intra-operative or postoperative complications were encountered. Conclusion:Supero temporal free conjunctivo-limbal auto graft appears to be a safe and effective technique in thesurgical management of pterygium. The inclusion of limbal tissue in the conjunctival auto graftfollowing pterygium excision appears to be essential to ensure low recurrence rate.Keywords: Conjunctival auto graft, limbal transplantation, pterygium, recurrence
Dushku N, Reid TW. Immunohistochemical evidence that
human pterygia originate from an invasion of vimentin–
expressing altered limbal epithelial basal cells. Curr Eye Res
Sebban A, Hirst LW, Kynaston B, Bain C. Pterygium
recurrence rate at the princess Alexandra Hospital, Aust NZ J
Singh G, Wilson MR, Foster CS. Long term follow up study
of mitomycin eye drops as adjunctive treatment of pterygia
and its comparison with conjunctival autograft
transplantation. Cornea 1990;9:331–4.
Frucht-Pery J, Ilsar M, Hewmo I. Single dose of mitomycin –
C for prevention of recurrent pterygium: Preliminary report.
Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival
autograft transplantation for advanced and recurrent
pterygium. Ophthalmology 1985;92:1461–70.
Rubinfeld RS, Pfister RR, Stein RM, Foster Cs, Martin NF,
Stoleru S, et al. Serious complications of topical mitomycinC after pterygium surgery. Ophthalmology 1992;99:1647–54.
Hayasaka S, Noda S, Yamamoto Y, Setogawa T.
Postoperative instillation of low dose mitomycin-C in the
treatment of primary pterygium. Am J Ophthalmol
Helal M, Messiha N, Amayem A, El-maghjaby A, El Sherif,
Dabees M. Intraoperative mitomycin-C versus postoperative
topical mitomycin-C drops for the treatment of pterygium.
Ophthalmic Surg Lasers 1996;27:674–8.
Yamanouchi U, Takaku I, Tsuda N, Kajiwara Y, Mine M,
Ueno Y. Scleromalacia presumably due to mitomycin-C
instillation after pterygium excision.Jpn J Clin Ophthalmol
Chen PP,Ariyasu RG, Kaza V,Labree LD, Mc Donnell PJ. A
randomized trial comparing mitomycin –C and conjunctival
autograft after excision of primary pterygium. Am J
Lewallen SA. Randomized trial of conjunctival autografting for
pterygium in the tropics. Ophthalmology 1989;96:1612–4.
Koch JM, Mellin JB, Wauble TN. The pterygiumAutologous conjunctiva-limbus transplantation as treatment.
Guler M, Sobaci G, Liker S, Ozturk F, Muthi FM, Yildirim
E. Conjunctival autograft transplantation in cases with
recurrent pterygium. Acta Ophthalmol 1994;72:721–6.
Shimazaki J, Yang HY, Tsubota K. Limbal autograft
transplantation for recurrent and advanced pterygia.
Ophthalmic Surg Lasers 1996;27:917–23.
Rao SK, Lekha T, Mukesh BN, Sitalakshmi G, Padmanabhan
P. Conjunctival-limbal autograft for primary and recurrent
pterygia: Technique and results. Indian J Ophthalmol
Pulte P, Heiligenhaus A, Koch J. Long term results of
autologous conjunctiva-limbus transplantation in pterygium.
Klin Monatsbl Augenheilkd 1998;213:9–14.
Mutlu FM, Sobaci G,Tatar T, Yildirim E. A comparative
study of recurrent pterygium surgery: Limbal conjunctival
autograft transplantation versus mitomycin-C with
conjunctival flap. Ophthalmology 1999;106:817–21.
Figueiredo RS, Cohen EJ, Gomes JAP, Rapuano CJ, Laibson
PR. Conjunctival autograph for pterygium surgery: how well
does it prevent recurrences? Ophthalmic Surg Lasers
Tseng SCG, Chen JJY, Huang AJW, Kruse FE, Maskin SL,
Tsai RJF. Classification of conjunctival surgeries for corneal
diseases based on stem cell concept. Ophthalmol Clin North
Vtabec MP, Weisenthal RW, Elsing SH. Subconjunctival
fibrosis after conjunctival auto grafts. Cornea 1993;12:181–3.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.