J Korean Ophthalmol Soc.  2016 Dec;57(12):1866-1873. 10.3341/jkos.2016.57.12.1866.

The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium

• Kim SY
• Ko SJ

• KMID: 2362703
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1866

Abstract

PURPOSE
In the present study, the effect of the inferior conjunctival transposition flap in patients with recurrent pterygium was evaluated.
METHODS
This study included 60 patients (63 eyes) that received pterygium surgery with inferior conjunctival transposition flap and diagnosed with recurrent pterygium. The inferior conjunctival transposition flap obtained from lower bulbar conjunctiva was secured with 8-0 VICRYL® after removal of recurrent fibrovascular tissues. This study was retrospectively reviewed for recurrence and postoperative complications in patients with a minimum follow-up period over 6 months.
RESULTS
The mean follow-up period was 5 years and 8 months (range; 6 months to 14 years). Corneal recurrence occurred in 4 eyes (6.3%) and conjunctival recurrence was observed in 2 eyes (3.1%) among a total of 63 eyes. Conjunctival recurrence was not the progressive type and limited to the limbus and suture site. One case of corneal recurrence required additional symblepharolysis and auto conjunctival graft. Although mild flap congestion, hemorrhage and granuloma were observed, these cases improved during the follow-up period.
CONCLUSIONS
The inferior conjunctival transposition flap procedure can be regarded as an effective surgical treatment option for recurrent pterygium.

Keyword

Inferior conjunctival transposition flap; Recurrent pterygium

MeSH Terms

Conjunctiva
Estrogens, Conjugated (USP)
Follow-Up Studies
Granuloma
Hemorrhage
Humans
Postoperative Complications
Pterygium*
Recurrence
Retrospective Studies
Sutures
Transplants
Estrogens, Conjugated (USP)

Figure

• 

  Figure 1 Surgical technique of the inferior conjunctival transposition flap. (A) The pterygial tissue was removed as indicated by the incisional marking (dotted line). (B) The conjunctival flap was made from the inferior conjunctiva near limbus. (C) The conjunctival flap was transpositioned with rotation to the excision site of pterygium. (D) The conjunctival flap was secured to adjacent conjunctiva with few interrupted sutures of 8–0 vicryl.

• 

  Figure 2 Anterior segment photographies of the corneal recurrence patient. (A) Before surgery. (B) Grade 3 recurrence of pterygium after surgery. The fibrovascular tissue was observed to invade cornea at the postoperative 4 months. In the comparison of pre-operative and postoperative photograph, it showed that the aspect of recurred pterygium after surgery was mild in size and fibrosis.

• 

  Figure 3 Anterior segment photographies of the conjunctival recurrence patient. (A) Before surgery. (B) Grade 2 recurrence of pterygium after surgery. The limbal fibrovascular tissue was observed at the postoperative 6 months. This aspect of fibrovascular tissue becames inflamed slightly weaker, less vascularized, non-progressive than before surgery.

• 

  Figure 4. Complications after inferior conjunctival transposition flap surgery. (A) Pterygium recurrence associated with sym-blepharon attached to lower lid was observed in five months. For treatment, additional surgery of symblepharolysis and au-to-conjunctival graft was required. (B) The granuloma was observed in tenon capsule three weeks after surgery. It improved during the observation to respond well to steroid therapy. (C) The ocurrence of conjunctival cyst was seen in the 3 months of postoperative observation.

Reference

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