J Korean Ophthalmol Soc.  2018 Dec;59(12):1114-1121. 10.3341/jkos.2018.59.12.1114.

Long-term Outcomes of Conjunctivo-limbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

• Chung IK
• Kim JH
• Lee JH
• Lee DH

• KMID: 2428682
• DOI: http://doi.org/10.3341/jkos.2018.59.12.1114

Abstract

PURPOSE
We report the clinical outcomes of patients undergoing additional widening of the limbal incision to prevent disease recurrence after conjunctivo-limbal autograft combined with pterygial excision.
METHODS
We retrospectively compared 95 eyes with primary and 12 eyes with recurrent pterygia randomized to treatment via two surgical methods: conjunctivo-limbal autograft alone and combined with widening of the limbal incision to allow for pterygial removal. We widened the limbal incisions by 1 mm on both the superior and inferior limbal margins and removed the pterygia. The outcomes were compared between 39 eyes undergoing conjunctivo-limbal autograft alone and 68 eyes undergoing conjunctivo- limbal autograft with widening of the limbal incision.
RESULTS
The mean overall postoperative follow-up period was 29.6 ± 10.5 months and conjunctivo-limbal autograft alone group was 27.4 ± 11.5 months, combined with widening of the limbal incision group was 30.7 ± 9.7 months. Six pterygia (15.4%; four primary and two recurrent) developed in those undergoing conjunctivo-limbal autograft alone and two (2.9%; one primary and one recurrent) in those undergoing additional widening of the limbal incision; the recurrence rate differed significantly between the two groups (p < 0.05). In the group treated with conjunctivo-limbal autograft alone, the mean time to development of a new primary pterygium was 6.3 ± 3.4 months and that to development of a recurrent pterygium 4.3 ± 2.5 months; the respective values for the group undergoing additional widening of the limbal incision were 12.1 ± 2.6 and 8.4 ± 4.6 months; the recurrence rates differed significantly (p < 0.05).
CONCLUSIONS
Conjunctivo-limbal autograft with additional widening of the limbal incision used to treat both new primary and recurrent pterygia was more effective in terms of reducing pterygial recurrence than conjunctivo-limbal aAutograft alone.

Keyword

Limbal; Pterygium; Recurrence; Transplantation; Widening

MeSH Terms

Autografts*
Follow-Up Studies
Humans
Pterygium
Recurrence
Retrospective Studies
Transplantation

Figure

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  Figure 1. Surgical technique of conjunctivo-limbal autograft combined with widening of the limbal incision in pterygium. (A) Pterygium incision area was marked by Gentian violet and the area where pterygium's body met limbus was also marked by Gentian violet to locate additional widening of limbal incision area. On each superior and inferior margin of limbus where the pterygium was removed. (B) Fibrovascular tissues that built up on the exposed sclera surface were removed sufficiently using Westcott scissor and #15 blades to eliminate any residuals in limbus. (C) Extra 1 mm incision was carried out in the additional widening limbal incision area where it was marked in (A). (D) After suture of both margins of limbus, 10–0 Nylon was grafted by interrupted suture and then fixation suture was carried out in episclera parallel to limbus to prevent grafted area from moving.

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  Figure 2. The preoperative and postoperative photographs of patients who have pterygium with conjunctivo-limbal autograft alone and combined with widening of the limbal incision. (A, B) Preoperative anterior segment photos of pterygium. (C) Postoperative 6 months after conjunctivo-limbal autograft alone. (D) postoperative 6 months after conjunctivo-limbal autograft combined with widening of the limbal incision.

Reference

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