Conjunctival Autograft Transplantation Research Articles

Long-term results of limbal conjunctival autograft transplantation associated with an amniotic membrane in patients with total limbal stem cells deficiency

Long-term results of limbal conjunctival autograft transplantation associated with an amniotic membrane in patients with total limbal stem cells deficiency

Clinical observation of pterygium excision combined with conjunctival autograft for the treatment of pterygium

Objective To observe the therapeutic effect of pterygium excision combined with autologous conjunctival transplantation in the treatment of pterygium. Methods The medical records of 95 eyes of 80 cases with pterygium in our hospital from February 2011 to January 2012 were analyzed.The patients were divided into two groups randomly.The observation group had 47 eyes of 40 cases and the control group had 48 eyes of 40 cases.The pterygium had been resected under a microscope.The patients of the observe group had been transplanted with autologous limbal conjunctiva on the the pterygium excised area.All patients had been followed-up for 3 years after surgery. Results 86 eyes of 71 cases (90.53%) of pterygium were fully cured with normal wound healing and transparent corneal epithelia. Only 9 cases (9.47%) had recurrenced, in which 1 case from the observation group and 8 cases from the control group. The recurred cases returned to normal after the secondary operation. Conclusion Pterygium excision with conjunctival autograft transplantation promotes the rapid recovery of ocular surface structure and function, and it has important significance to reduce the recurrent rate. Key words: Pterygium; Transplantation, conjunctival, limbal

Living-related limbal allograft transplantation for bilateral stem cell deficiency in a patient with bilateral chemical burn

INTRODUCTION. The purpose of this paper was to report the long-term outcome of a living-related limbal allograft transplantation followed by penetrating keratoplasty in a patient with severe bilateral stem cell deficiency. MATERIALS AND METHODS. A 50-year-old woman presented with extensive bilateral stem cell deficiency secondary to ocular acid burn on both eyes. Visual acuity was counting fingers at 30 cm on the right eye and counting fingers at 1 m Snellen line on the left. Limbal allograft transplantation on the right eye from a first-degree living-related relative was performed. The recipient was prepared by removing the abnormal corneal epithelium and vascularised pannus of the right eye under general anaesthesia. Two limbal allografts (mean length of 2–3 corresponding anatomic posi­tions on the recipient). Postoperatively, the host received systemic immunosuppression (steroids and cyclosporine). RESULTS. The cornea of the right eye achieved reepithelialisation within two weeks after surgery, followed by re­duction in vascularity in eight weeks time. After one year of regular follow up, the corneal surface remained stable whereas the stroma was opaque and the vision was low. Therefore, the patient underwent penetrating keratoplasty on the same eye. After the surgery the corneal graft was clear and the visual acuity on the right eye improved to 20/50 Snellen line. No graft rejection occurred after a five-year follow-up. CONCLUSION. Living-related limbal allograft transplantation is a good alternative option in cases of total bilateral stem cell deficiency whenever a conjunctival limbal autograft transplantation is not possible.

Investigation on the effects of eye drops of 0.3% hyaluronate sodium on ocular surface of after pterygium surgery

Objective To evaluate the the effects of 0.3% hyaluronate sodium eye drops on ocular surface of pterygium patients after limbal conjunctival autograft transplantation. Methods Prospective, double-blind, randomized, controlled clinical trial. Sixty eyes of 60 patients diagnosed as primary pterygium were randomly divided into two groups with 30 eyes in each group. All received pterygium resection combined with limbal conjunctival autograft transplantation by the same doctor. After operation, patients in the control group were given 0.5% levofloxacin, 0.1% fluorometholone eye drops 4 times a day. For that in treatment group, 0.3% sodium hyaluronate eye drops were added 1 day postoperatively, four times a day for 1 month. The follow-up time was 1 month. The healing of epithelium, the scores of clinical symptoms, corneal sensation, non-invasive breakup time of tear film (BUT), non-invasive tear meniscus height (TMH), and confocal microscopy examination were done and recorded. Results The scores of clinical symptoms at the 2, 3, 7 days after the surgery were lower in the treatment group than that in the control group(P 0.05). At day 2, the eyes with intact epithelium in treatment group was 17(57%), compared with control group only 9(30%)(χ2=4.344, P=0.037). TMH & BUT: at 14 and 28 days postoperatively, the TMH in the treatment group were higher than that in the control group(P 0.05). Corneal sensation: at each time point, there was no statistically significant difference between two groups(P>0.05). Confocal microscopy: at 7 days postoperatively, the epithelia of the pterygium resection area were assembled tightly without edema or inflammation cells infiltration in the treatment group; however, in the control group, some of the epithelial cells were swollen with inflammation cells infiltration. The corneal epithelial cells density was higher in the treatment group compared with the control group(P<0.05). Conclusion 0.3% hyaluronate sodium eye drops promote the healing of corneal epithelium, and significantly reduce the perioperative pain. Continual using 0.3% hyaluronate sodium eye drops could increase the TMH. Key words: Pterygium; Excision; Eye drops, hyaluronate sodium; Wound healing

Conjunctival autograft for pterygium.

Conjunctival autograft for pterygium.

Long-term comparison of limbal conjunctival autograft and bare sclera technique in pterygium surgery: a five-year follow-up trial

To compare the long-term results of limbal conjunctival autograft transplantation (LCAT) and bare sclera (BS) technique in pterygium surgery. The records of patients who underwent pterygium surgery with LCAT in the Sifa University Hospital and Batigoz Eye Health Center between April 2009 and February 2010 were retrospectively reviewed. The results are evaluated and compared with the chi-square test. A total of 258 patients, who had primary pterygium, were operated during the period of April 2009 and February 2010 with the BS technique and LCAT. A total of 179 eyes of 179 patients were included in the study. The mean follow-up period was 56.2 ± 4.3 months. A total of 34 of them were operated with the BS technique. A total of 145 patients underwent pterygium excision combined with LCAT. Recurrence was detected in 11 patients (32.35 %) who were operated with the BS technique and in 6 patients (4.13 %) with LCAT. The recurrence rates in the BS group were higher than the limbal conjunctical autograft group (p < 0.05). LCAT is an effective and safe treatment for primary pterygium.

Results of pterygium excision adjunct with conjunctival autograft transplantation for primary pterygium by ophthalmology trainees.

To evaluate the results of pterygium excision with conjunctival autograft transplantation for primary pterygium performed by trainee ophthalmologists. Design Prospective interventional case series. Setting A tertiary eye care center in northern Thailand. Participants Patients with primary pterygium recruited from July 2011 to August 2012. Intervention In all cases, the affected eye underwent pterygium excision followed by a superior conjunctival autograft carried out by trainee ophthalmologists. Main outcome measure The recurrence of pterygium and other post-operative complications. Results Sixty-two eyes from 54 patients were studied. There were 36 females (66.7%) and 18 males (33.3%). The mean age of the patients was 54.5 (±9.8) years with the mean corneal invasion measured at 3.3(±0.8) mm. Pterygium morphologies of Grade 1, Grade 2, and Grade 3 were 33.9, 48.4, and 17.7%, respectively, with the mean follow-up time of 17.3 (±7.9) months. Pterygium recurred in the cornea of six eyes (9.7%). All recurrences occurred within 6-month post-operation. Other post-operative complications included conjunctival recurrence (4.8%), graft retraction (3.2%), conjunctival cyst (3.2%), and increased intraocular pressure (1.6%). The recurrence of pterygium was not associated with the patient age (p=0.72), occupation (p=0.23), sun exposure time (p=0.18), pterygium duration (p=0.22), pterygium size (p=0.67), or pterygium morphology (p=0.85). Conclusion The recurrence rate and post-operative complications of pterygium excision with conjunctival autograft performed by trainee ophthalmologists were within acceptable limits. All recurrence occurred within 6months after surgery.

Double-Layered Conjunctival Autograft and Amniotic Membrane Transplantation to Treat Restrictive Esotropia and Hypotropia

Double-Layered Conjunctival Autograft and Amniotic Membrane Transplantation to Treat Restrictive Esotropia and Hypotropia

A Study of Limbal Conjunctival Autograft Transplantation in Primary Pterygium

Aim : To study limbal conjunctival autograft transplantation in primary pterygium. Material and Methods: The present study was conducted on 100 eyes of 100 patients with primary pterygium attending the outpatient department of Ophthalmology department of Dr. Vasantrao Pawar Medical college, Nashik from July 2011 to June 2013 who were managed by Limbal Conjunctival Autografting(LCAT) which were performed by single surgeon. Result : This study shows that most of the patients belonged to age groups of 31-70. The mean pre-op astigmatism of 2.60 +2.20 Diopters (D) significantly reduced to 1.28 +1.22D postoperatively. There is significant improvement in Post operative Best Corrected Visual Acuity (BCVA) compared to preoperative BCVA with difference of 0.17+0.02. Postoperatively out of 100 eyes, 4 recurrences occurred with recurrence rate of 4%. Conclusion : Limbal Conjunctival Autograft transplantation is a safe and effective technique in management of Pterygium.

A Study of Limbal Conjunctival Autograft Transplantation in Primary Pterygium

&lt;strong&gt;Aim&lt;/strong&gt;: To study limbal conjunctival autograft transplantation in primary pterygium. &lt;strong&gt;Material and Methods:&lt;/strong&gt; The present study was conducted on 100 eyes of 100 patients with primary pterygium attending the outpatient department of Ophthalmology department of Dr. Vasantrao Pawar Medical college, Nashik from July 2011 to June 2013 who were managed by Limbal Conjunctival Autografting(LCAT) which were performed by single surgeon. &lt;strong&gt;Result&lt;/strong&gt;: This study shows that most of the patients belonged to age groups of 31-70. The mean pre-op astigmatism of 2.60 +2.20 Diopters (D) significantly reduced to 1.28 +1.22D postoperatively. There is significant improvement in Post operative Best Corrected Visual Acuity (BCVA) compared to preoperative BCVA with difference of 0.17+0.02. Postoperatively out of 100 eyes, 4 recurrences occurred with recurrence rate of 4%. &lt;strong&gt;Conclusion&lt;/strong&gt;: Limbal Conjunctival Autograft transplantation is a safe and effective technique in management of Pterygium.

Corneal Wavefront Aberrations After Primary and Recurrent Pterygium Surgery.

To evaluate the effect of primary and recurrent pterygium surgery on corneal wavefront aberrations. This prospective and interventional study included the 47 eyes of 47 patients with primary pterygium (primary group) and 41 eyes of 41 patients with recurrent pterygium (recurrent group). All patients underwent pterygium excision with conjunctival autograft transplantation. Corneal wavefront aberrations were measured using Sirius corneal topography and aberrometry system (Costruzione Strumenti Oftalmici, Florence, Italy) before surgery and at 3 and 12 months after surgery. The main outcome measures were root mean square values of total wavefront error (WFE), higher-order aberrations (HOAs), coma, trefoil, and spherical aberrations. Corneal wavefront aberrations were not significantly different between the primary and recurrent groups at baseline (P>0.05). Total WFE, HOA, trefoil, and coma decreased significantly in both primary and recurrent groups at postoperative 3 and 12 months compared with preoperative measurements (P<0.05). The mean spherical aberration was not significantly changed at 3 and 12 months compared with preoperative measurements (P>0.05). Total WFE, HOA, trefoil, and coma were significantly higher in the recurrent group than in the primary group at postoperative 3 and 12 months (P<0.05). Pterygium surgery can significantly reduce corneal wavefront aberrations, including total WFE, HOA, trefoil, and coma in eyes with primary or recurrent pterygium. However, postoperative corneal aberrations were higher in the recurrent group than in the primary group.

Influence of pterygium excision surgery on corneal biomechanical properties

AbstractPurpose To evaluate biomechanical corneal changes after pterygium excision surgery.Methods Prospective, interventional study in which 22 patients with unilateral pterygium were enrolled. Patients underwent pterigyum excision surgery with conjunctival autograft transplantation. The following corneal biomechanical properties were studied using Ocular Response Analyzer (ORA), preoperatively and postoperatively: Corneal Resistance Factor (CFR), Corneal Hysteresis (CH), Goldman correlated intraolcular pressure (IOPg) and Corneal Compensated IOP (IOPcc).Results CRF increased after pterygium excision surgery. Nevertheless, CRF returned to normal values at day 30. There was a decrease in CH parameters at day 7 and at day 30 compared with preoperative values. There was an increase in IOP, IOPg and IOPcc postoperatively.Conclusion CH decreases after pterygium surgery probably because of the elimination of a biomechanical reinforcement provided by the fibrovascular tissue that invades the anterior stroma. The postoperative decrease in CH could influence the IOP measure, which could be infraestimated using the Golman applanation technique. ORA postoperavtive exploration provides more precise IOP values.

Vascularization of Conjunctival Autografts in Pterygium Surgery: Comparison of Fibrin Glue with Sutures

To monitor the development of graft vascularization after pterygium excision with conjunctival autograft transplantation (CAT) using indocyanine green angiography (ICGA) and to compare the graft vascularization between 2 different fixation techniques (fibrin glue and sutures). A total of 26 eyes of 26 patients with primary pterygium were randomly assigned after pterygium excision as having either fibrin glue (13 eyes) or Vicryl sutures (13 eyes) for CAT. Anterior segment ICGA findings were evaluated postoperatively at 1, 7, and 15 days and the percentages of graft vascularization in both groups were compared using pixel analysis software program. The mean ± SD age of patients in the suture and fibrin glue groups was 52.1 ± 12.7 years and 57.1 ± 9.82 years, respectively. There was no statistically significant difference between the groups regarding age, sex, or follow-up (p&lt;0.05 for all). Also, the mean intraoperative defect size was not significantly different between the groups, which was measured as 20.11 ± 10.44 mm2 in the suture group and 23.44 ± 12.34 mm2 in the fibrin glue group (p = 0.343). The mean percentage of vascularized graft area at postoperative day 1 and 7 was 18.1 ± 7.8% and 25.3 ± 8.6% in the suture group and 34.8 ± 10.2% and 66.1 ± 17.8% in the fibrin glue group. The difference between the groups was statistically significant (p&lt;0.01 for both). At postoperative day 15, all grafts were 100% perfused in both groups. Fibrin glue fixation of conjunctival autografts led to more vascularization in the early postoperative period than suture fixated grafts, which in turn may have significance in terms of graft health and pterygium recurrence.

Combined conjunctival autograft and overlay amniotic membrane transplantation; a novel surgical treatment for pterygium.

The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.

Sealing the gap between conjunctiva and Tenon’s capsule in primary pterygium surgery

Objetive: To assess the results of an alternative surgical approach in the excision of primary pterygium by analyzing the rates of recurrence and of intraoperative and postoperative complications. Methods: Retrospective cross-sectional study based reviewing the clinical records of individuals subjected to surgery for pterygium, with conjunctival autograft transplantation, fibrin glue and intraoperative application of mitomycin C. In addition, sealing was performed by suturing the gap between the conjunctiva and Tenon’s capsule. A total of 36 eyes from 35 individuals were subjected to the assessed techniques. The study variables were complications of surgery and recurrence rates during a minimun follow-up period of 6 months. Results: No recurrence occurred during the follow-up period. One graft (2.8%) exhibited partial retraction, but pterygium did not recur. The intraocular pressure increased in one eye (2.8%) and was controlled by clinical methods. Conclusion: Eyes in which a barrier was established between the conjunctiva and Tenon’s capsule by sealing the gap between them showed an absence of recurrence in the sample studied. However, there is the need of a random prospective study with a control group for a more accurate conclusion on the efficacy of the technique

Comparison of conjunctival graft thickness after primary and recurrent pterygium surgery: anterior segment optical coherence tomography study.

Objective:The objective of the following study is to compare the conjunctival graft thickness measured with anterior segment optical coherence tomography (OCT) after primary and recurrent pterygium excision.Design:Prospective, interventional and comparative study.Participants:A total of 20 eyes of 20 patients with primary pterygium (primary group) and 20 eyes of 20 patients with recurrent pterygium (recurrent group) were enrolled.Materials and Methods:All patients underwent pterygium excision with conjunctival autograft transplantation. Conjunctival graft thickness was measured at 1 week, 1 month and 3 months after surgery using the Visante-OCT (Carl-Zeiss Meditec, Dublin, CA, USA). Main outcome measure was the mean conjunctival thickness determined as the mean of three measurements at 1, 2 and 3 mm posterior to the scleral spur.Results:There were no statistically significant differences in age, sex, or laterality between the groups. Mean thickness of the graft in primary and recurrent groups, respectively, was 430 ± 127 μm and 461 ± 178 μm at 1 week after surgery (P = 0.587), 114 ± 19 μm and 162 ± 48 μm at 1 month after surgery (P = 0.001) and 109 ± 15 μm and 107 ± 18 μm at 3 months after surgery (P = 0.726).Conclusion:The findings revealed that conjunctival thickness after primary or recurrent pterygium excision was greatest at 1 week after surgery and continued to decrease for up to 3 months. Mean graft thickness differed significantly between the two groups only at 1 month after surgery.

Topical Application of Bevacizumab as an Adjunct to Recurrent Pterygium Surgery

To evaluate the clinical outcomes of topical bevacizumab as adjunctive to the surgical excision for treatment of recurrent pterygium. The 44 patients who underwent recurrent pterygium excision with conjunctival autograft transplantation were enrolled in this prospective and interventional study. The patients were randomized in 2 groups: study group, 1 month after surgery, 22 patients received only topical bevacizumab (5 mg/mL) 4 times daily for 2 months; control group, 1 month after surgery, 22 patients were administered only an artificial tear 4 times daily for 2 months. Patients were prospectively followed for 6 months after pterygium surgery. The main outcome measures were pterygium recurrence, corneal neovascularization, and other postoperative complications. No statistically significant differences were observed between the 2 groups in terms of age, gender distributions, laterality, length of pterygium, and number of recurrence. A pterygium recurrence was not noted in any patients in the study group but was noted in 2 of 22 eyes (9%) in the control group during the follow-up after surgery (P = 0.244). Although none of the patients developed corneal neovascularization in the study group, 5 of 22 eyes (22.7%) developed this condition in the control group during the follow-up after surgery (P = 0.024). No serious complications were observed during the follow-up period in both the groups. Topical bevacizumab therapy 1 month after surgical excision of recurrent pterygium is well tolerated and effective to prevent neovascularization. Although the recurrence rate is lower in the study group without significant difference, further studies are required to support this result.

Conjunctival limbal autograft transplantation in pterygium surgery by natural haemostasis

History of pterygium surgery dates back to 1000 BC.1,2 In earlier days “Bare Sclera” technique for pterygium removal was popular, as it was considered simple procedure. However, simple excision was associated with a high rate of recurrence that may be more aggressive than the initial lesion.3 Subsequently, many techniques aimed at preventing recurrence have been described like radiation treatment and the use of antimetabolite chemicals that prevent the growth of tissue.4 Currently the most widely used technique involves excision of the pterygium and covering of the defect with conjunctival autograft or amniotic membrane. Initially, sutures were used to cover the defect with conjunctival autograft. Recent report favour the use of fibrin glue above sutures with improved comfort, decreased surgical time, reduced complication of recurrence rates.5 Conventional suturing causes complications like foreign body reaction, infection, scarring in maximum no of patients.5 Their application is slow and needs skill. In the search of solution of these problems, concept of tissue adhesive was floated.6 Fibrin glue is a biological tissue adhesive which initiates the final stages of coagulation when a solution of human fibrinogen is activated by thrombin. However, plasma derived fibrin glue has the potential risk of prion disease transmission and anaphylaxis in susceptible individuals. In our case, we have achieved conjunctival limbal autograft adherence by natural haemostasis. Natural coagulation in human tissue begins almost instantly whenever there is an injury to the blood vessel endothelium. Fibrin clot which is formed through coagulation cascade allows to secure a conjunctival limbal autograft in place on the eye.7

Outcome of conjunctival autograft sutured with polyamide black sutures in pterygium surgery

Pterygium excision with conjunctival autografting is the most effective way of treating pterygium with the least recurrence rate. The sutures which can be used to suture the conjunctival autograft are absorbable polyglactin 10-0 sutures or nonabsorbable polyamide 10-0 sutures. The polyamide sutures are inert, elicit minimal acute inflammatory reaction, do not support infection and allow easy removal without tissue adherence. They are very cost-effective compared to polyglactin sutures. This study was aimed to assess the efficacy of the cost-effective polyamide sutures in terms of patient comfort, graft stability, need for suture removal and recurrence. In this prospective, non-comparative study, 56 eyes of 56 patients with primary pterygium underwent pterygium excision with conjunctival autograft transplantation sutured with 10-0 polyamide black sutures. The patients' comfort, graft stability, need for suture removal and recurrence were assessed within a mean follow- up period of 28.75 months (range 47 - 14 months). Mild discomfort was found in 14 (25 %) patients for up to 3 weeks, moderate discomfort in 8 (14.2 %) for up to 1 week, no patients had severe discomfort beyond the first day, and all patients were comfortable at the end of the sixth post-operative week. The graft was stable in all patients. Nine sutures in 5 patients out of 392 sutures in 56 patients, that is, 2.29 % of the sutures, needed to be removed at the end of the sixth post-operative week. Two patients, or 3.57 %, had a recurrence. In pterygium surgery, suturing the conjunctival autograft with cost-effective polyamide black sutures is efficient and safe.

Effect of Fluorometholone/Tetrahydrozoline Fixed Combination on Conjunctival Autograft Morphology after Primary Pterygium Excision

Purpose. To evaluate the effect of a fluorometholone/tetrahydrozoline fixed combination on conjunctival graft morphology after primary pterygium excision. Methods. The patients who underwent pterygium excision with conjunctival autograft transplantation were randomized into three groups based on postoperative medications as the fluorometholone/tetrahydrozoline group, fluorometholone group, and dexamethasone group. Conjunctival graft thickness was measured with anterior segment optical coherence tomography. The conjunctival graft hyperemia was evaluated using a high definition external camera. Results. The mean graft thickness was significantly lower in the fluorometholone/tetrahydrozoline group compared with fluorometholone and dexamethasone groups at 2 weeks (P = 0.002 and P = 0.012, resp.) and at 1 month after surgery (P = 0.003 and P = 0.013, resp.). The conjunctival hyperemia score was significantly lower in the fluorometholone/tetrahydrozoline group compared with fluorometholone and dexamethasone groups at 2 weeks (P = 0.000 and P = 0.000, resp.) and at 1 month (P = 0.039 and P = 0.040, resp.). The graft thickness and conjunctival hyperemia score were similar among the groups at 1 week and 3 months (P > 0.05). Conclusion. The findings of the present study revealed that treatment with the fluorometholone/tetrahydrozoline fixed combination may be helpful to decrease graft edema and to achieve better cosmetic appearance at 2 weeks and 1 month after pterygium excision.