Head inversion technique to restore physiological conjunctival structure for surgical treatment of primary pterygium

Fumiaki Yoshitomi,Tetsuro Oshika

doi:10.1038/s41598-018-35121-z

Abstract

We describe a new surgical technique to treat primary pterygium, the head inversion technique, with its surgical outcomes. Seventy-five eyes of 75 consecutive patients with primary pterygium undergoing surgical treatment were included. The pterygium head and body were bluntly separated from the cornea and inverted onto the nasal conjunctival area. By injecting a balanced salt solution subconjunctivally, the conjunctiva was ballooned and smoothed. Two or three interrupted 8–0 virgin silk sutures were placed to secure the inverted conjunctiva in place. No adjunctive therapy was used during and after surgery. Postoperatively, one eye showed pterygium recurrence at 233 days, in which an unintended conjunctival hole was made during surgery. The Kaplan-Meier analysis showed that the recurrence rate at 1 year was 2.4%. In 43 eyes which were followed up for longer than 6 months, the vascular loop, which is characteristic of normal limbal structure, appeared on the nasal conjunctiva in 41 eyes (95.3%). The palisades of Vogt were found on the nasal limbus postoperatively in 13 eyes (30.2%). The pterygium head inversion technique was an effective treatment for primary pterygium. By separating the pterygium from the cornea and inverting the intact pterygium head onto the nasal conjunctival site, the conjunctiva restored near physiological status after surgery.

Highlights

A pterygium is a triangular, elevated, superficial, fibrovascular lesion that usually forms over the perilimbal conjunctiva and encroaches onto the corneal surface
Closure or grafting, and adjunctive therapy will inevitably affect the physiological status of the conjunctiva and compromise conjunctival barrier, which will not be fully recovered
We developed the current surgical technique aiming to reduce the rate of recurrence rate of pterygium after surgery

Summary

Introduction

A pterygium is a triangular, elevated, superficial, fibrovascular lesion that usually forms over the perilimbal conjunctiva and encroaches onto the corneal surface. The simplest surgical method for pterygium treatment is bare sclera excision, leaving the bulbar conjunctival defect after pterygium removal uncovered and letting the surrounding conjunctiva migrate over the area of exposed sclera on its own. This technique was, associated with high recurrence rate[4,5], and replaced by other more complicated and sophisticated methods. Closure or grafting, and adjunctive therapy will inevitably affect the physiological status of the conjunctiva and compromise conjunctival barrier, which will not be fully recovered To overcome these drawbacks, we developed a new technique for the treatment of pterygium. Our method does not entail excision and incision of pterygium, but attempts to restore conjunctival structure and barrier function to the normal condition as much as possible

Methods

Results

Conclusion