J Korean Ophthalmol Soc.  2019 Feb;60(2):109-118. 10.3341/jkos.2019.60.2.109.

Analysis of Donor-site Complications after Conjunctivo-limbal Autograft to Treat Pterygium

• Huh MG
• Park DJ

• KMID: 2438069
• DOI: http://doi.org/10.3341/jkos.2019.60.2.109

Abstract

PURPOSE
To evaluate the types, frequency, and causes of complications at the donor site after conjunctivo-limbal autograft for primary or recurrent pterygium treatment.
METHODS
From January 2010 to December 2016, 91 eyes of 91 patients (male, n = 37; female, n = 54; mean age, 53.29 ± 10.73 years), diagnosed with primary or recurrent pterygium, and who were followed up for 6 months or longer after conjunctivo-limbal autograft, were enrolled in this study retrospectively.
RESULTS
Of the 91 eyes, 27 eyes (29.7%) developed a conjunctival scar on the donor site and 36 eyes (39.6%) had localized vascularization. Eighteen eyes (19.8%) had a conjunctival scar and localized vascularization. Conjunctival granuloma and limbal stem cell deficiency occurred in one eye (1.1%). Multiple regression analysis showed that having a conjunctival scar and localized vascularization were significantly correlated with young age (p < 0.001), but were not significantly correlated with gender, pterygium type, dry eye, conjunctivochalasis, hypertension, diabetes, anticoagulant treatment, graft size, or delayed epithelial-wound healing.
CONCLUSIONS
Conjunctival scarring or localized vascularization on the donor site after conjunctivo-limbal autograft for the treatment of the pterygium was found to be significantly higher in younger patients. Therefore, it is recommended that conjunctivo-limbal autograft should be adequately explained for donor-site complications in younger-aged pterygium patients.

Keyword

Complication; Conjunctivo-limbal autograft; Donor site; Pterygium

MeSH Terms

Autografts*
Cicatrix
Female
Granuloma
Humans
Hypertension
Pterygium*
Retrospective Studies
Stem Cells
Tissue Donors
Transplants

Figure

• 

  Figure 1 The size of conjunctivolimbal autograft. The width was calculated by the trapezoidal width formula. a = base; b = upper side of base; h= height.

• 

  Figure 2 The number of patients according to the age group classified by period of epithelial wound healing. The rate of delayed epithelial wound healing was higher in the older age group.

• 

  Figure 3 Anterior segment photographs show donor-site complication. No complication (A). Conjunctival scarring (circle) (B). Vascularization (circle) (C). Conjunctival scarring and vascularization (circle) (D). Conjunctival granuloma (circle) (E). Focal lim - bal stem cell deficiency (circle) (F).

Reference

1. Dushku N, John MK, Schultz GS, Reid TW. Pterygia pathogenesis: corneal invasion by matrix metalloproteinase expressing altered limbal epithelial basal cells. Arch Ophthalmol. 2001; 119:695–706.

2. Pinkerton OD, Hokama Y, Shigemura LA. Immunologic basis for the pathogenesis of pterygium. Am J Ophthalmol. 1984; 98:225–228.

3. Threlfall TJ, English DR. Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol. 1999; 128:280–287.

4. Lee SH, Jeong HJ. Immune reactions in pterygium. J Korean Ophthalmol Soc. 1987; 28:927–933.

5. Dadeya S, Malik KP, Gullian BP. Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft. Ophthalmic Surg Lasers. 2002; 33:269–274.

6. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol. 1997; 115:1235–1240.

7. Güler M, Sobaci G, Ilker S, et al. Limbal-conjunctival autograft transplantation in cases with recurrent pterygium. Acta Ophthalmol (Copenh). 1994; 72:721–726.

8. Ti SE, Tseng SC. Management of primary and recurrent pterygium using amniotic membrane transplantation. Curr Opin Ophthalmol. 2002; 13:204–212.

9. Solomon A, Pires RT, Tseng SC. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology. 2001; 108:449–460.

10. Sánchez-Thorin JC, Rocha G, Yelin JB. Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium. Br J Ophthalmol. 1998; 82:661–665.

11. Polute P, Heilinggenhaus A, Koch J, et al. Long-term results of autologous conjunctival-limbus transplantation in pterygium. Klin Monbl Augenheilkd. 1998; 213:9–14.

12. Shimazaki J, Yang HY, Tsubota K. Limbal autograft transplantation for recurrent and advanced pterygia. Ophthalmic Surg Lasers. 1996; 27:917–923.

13. Kim CH, Lee JK, Park DJ. Recurrence rates of amniotic membrane transplantation, conjunctival autograft and conjunctivolimbal autograft in primary pterygium. J Korean Ophthalmol Soc. 2009; 50:1780–1788.

14. Kenyon KR, Tseng SC. Limbal autograft transplantation for ocular surface disorders. Ophthalmology. 1989; 96:709–723.

15. Al Fayez MF. Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 2002; 109:1752–1755.

16. Vrabec MP, Weisenthal RW, Elsing SH. Subconjunctival fibrosis after conjunctival autograft. Cornea. 1993; 12:181–183.

17. Leonardi A, Radice M, Fregona IA, et al. Histamine effects on conjunctival fibroblasts from patients with vernal conjunctivitis. Exp Eye Res. 1999; 68:739–746.

18. Leonardi A, Cortivo R, Fregona I, et al. Effects of Th2 cytokines on expression of collagen, MMP-1, and TIMP-1 in conjunctival fibroblasts. Invest Ophthalmol Vis Sci. 2003; 44:183–189.

19. Zada M, Pattamatta U, White A. Modulation of fibroblasts in conjunctival wound healing. Ophthalmology. 2018; 125:179–192.

20. Tan D. Conjunctival grafting for ocular surface disease. Curr Opin Ophthalmol. 1999; 10:277–281.

21. Jhagta HS, Jain P. Limbal stem cell deficiency: a review. J Ophthalmol Clin Res. 2015; 3:71–75.

22. Holland EJ, Schwartz GS. Iatrogenic limbal stem cell deficiency. Trans Am Ophthalmol Soc. 1997; 95:95–107.

23. Bae SG, Lee JK, Park DJ. Effectiveness of wide excision of subconjuncival fibrovascular tissue with conjunctivo-limbal autograft in pterygium surgery. J Korean Opthalmol Soc. 2012; 53:215–222.

24. Gosain A, DiPietro LA. Aging and wound healing. World J Surg. 2004; 28:321–326.

25. Swift ME, Kleinman HK, DiPietro LA. Impaired wound repair and delayed angiogenesis in aged mice. Lab Invest. 1999; 79:1479–1487.

26. Swift ME, Burns AL, Gray KL, DiPietro LA. Age-related alterations in the inflammatory response to dermal injury. J Invest Dermatol. 2001; 117:1027–1035.

27. Keylock KT, Vieira VJ, Wallig MA, et al. Exercise accelerates cutaneous wound healing and decreases wound inflammation in aged mice. Am J Physiol Regul Integr Comp Physiol. 2008; 294:R179–R184.

28. Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007; 117:1219–1222.

29. Liu ZJ, Velazquez OC. Hyperoxia, endothelial progenitor cell mobilization, and diabetic wound healing. Antioxid Redox Signal. 2008; 10:1869–1882.

30. Gozawa M, Takamura Y, Miyake S, et al. Prospective observational study of conjunctival scarring after phacoemulsification. Acta Ophthalmol. 2016; 94:e541–e549.