Optimal size of pterygium excision for limbal conjunctival autograft using fibrin glue in primary pterygia

Ho Sik Hwang,Roy S Chuck,Ji Won Kwon,Kyong Jin Cho,Gabriel Rand

doi:10.1186/s12886-018-0790-6

Abstract

BackgroundIn our study we describe a method that optimizes size of excision and autografting for primary pterygia along with the use of intraoperative MMC and fibrin glue. Our objective is to propose a simple, optimizedpterygium surgical technique with excellent aesthetic outcomes and low rates of recurrence and otheradverse events.MethodsRetrospective chart review of 78 consecutive patients with stage III primary pterygia who underwent an optimal excision technique by three experienced surgeons. The technique consisted of removal of the pterygium head, excision of the pterygium body and Tenon’s layer limited in proportion to the length of the head, application of intraoperative mitomycin C to the defect, harvest of superior bulbar limbal conjunctival graft, adherence of graft with fibrin glue. Outcomes included operative time, follow up period, pterygium recurrence, occurrences of incorrectly sized grafts, and other complications.ResultsAll patients were followed up for more than a year. Of the 78 patients, there were 2 cases of pterygium recurrence (2.6%). There was one case of wound dehiscence secondary to small-sized donor conjunctivaand one case of over-sized donor conjunctiva, neither of which required surgical correction. There were no toxic complications associated with the use of mitomycin C.ConclusionCorrelating the excision of the pterygium body and underlying Tenon’s layer to the length of the pterygium head, along with the use intraoperative mitomycin C, limbal conjunctival autografting, and fibrin adhesionresulted in excellent outcomes with a low rate of recurrence for primary pterygia.

Highlights

In our study we describe a method that optimizes size of excision and autografting for primary pterygia along with the use of intraoperative mitomycin C (MMC) and fibrin glue
A 2016 Cochrane meta-analysis examined the two most currently popular techniques, limbal conjunctival autografting and amniotic membrane grafting, and found conjunctival autografting superior with respect to lower 6 month recurrence rates [2]
Hwang et al BMC Ophthalmology (2018) 18:135 pterygium head to extensive subconjunctival dissection and excision of the entire pterygium to the point of insertion [7,8,9,10,11,12]. We developed this technique because we believe that the size of excision and graft for primary pterygia should be a continuous function based on the tissue’s aggressiveness as measured by the size of the pterygium head

Summary

Introduction

In our study we describe a method that optimizes size of excision and autografting for primary pterygia along with the use of intraoperative MMC and fibrin glue. Hwang et al BMC Ophthalmology (2018) 18:135 pterygium head to extensive subconjunctival dissection and excision of the entire pterygium to the point of insertion [7,8,9,10,11,12]. We developed this technique because we believe that the size of excision and graft for primary pterygia should be a continuous function based on the tissue’s aggressiveness as measured by the size of the pterygium head

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