Conjunctival Autograft Research Articles

Effectiveness of Sub-Conjunctival Bevacizumab After Pterygium Excision at Armed Forces Institute of Opthalmology

Objective: To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Aug 2019 to Jan 2020.
 Methodology: Thirty-six patients were included and divided into two groups. In group A (n=18), pterygium excision with conjunctival auto-graft was followed by injection of 0.3ml of 7.5mg of Bevacizumab. Patients of Group B (n=18) did not receive any Bevacizumab. All the patients were followed up after 7 days, two weeks, 4weeks and 24 weeks after the start of management. The visual analog score was used for pain assessment, Snellen chart for visual acuity and intraocular pressure was measured with applanation tonometry.
 Results: After six months the recurrence rate was less in Group-A (n=3, 16.6%, p=0.005) than Group-B (n=4, 22.2%, p=0.01) The recurred pterygium size was also greater in Group-B (mean=0.27 ± 0.28mm, p=0.006) than Group-A (mean=0.11 ± 0.21mm, p=0.006). Patients of Group-A experienced less pain post-surgery. The intraocular pressures were same in both the groups. Visual acuity improvement was seen in the Group-A (n=11, 61%, p=0.008)) than group B (n=4.22%, p=0.008).
 Conclusion: Administration of Bevacizumab under the conjunctiva after pterygium excision may be useful in averting lesion relapse, less post-op pain, and improved visual acuity.

Clinical study of recurrence rate following limbal- conjunctival autograft as a surgical treatment of pterygium

Background: Objective: To study the rate of recurrence following limbal- conjunctival autograft after a follow up period of 6-12 months. Methods: The source of data in this study is from the outpatient and inpatient department of ophthalmology, Chigateri general hospital and Bapuji hospital attached to J.J.M medical college, Davanagere during the period of September 2001 - March 2004. Results: A recurrence rate of 7.5% (3 eyes) was observed during a follow up period of 6-12 months .Of 3 eyes, one was recurrent pterygium and the other two primary pterygium. The 3 patients were aged 32,31 and 55 years and recurrence was observed at 1 month,2 months and 2 and a half months respectively. Conclusion: Pterygium excision with limbal conjunctival autograft is an excellent procedure for pterygium management. The technique is safe and inexpensive and is recommended for the management of both primary and recurrent pterygia in Indian eyes.

Changes in Visual Acuity and Keratometry Readings following Pterygium Excision: A Study in A Public Medical College Hospital

Introduction: Pterygium is a degenerative, triangular wing shaped, fibro vascular connective tissue of bulbar conjunctiva towards and onto the cornea, leading to significant astigmatism. It is a common ophthalmic condition of tropical and sub-tropical country like Bangladesh where there is dry sunny hot dusty climate.
 Purpose: To find out the change in visual acuity and keratomety before and after pterygium excision and effect of different grades of pterygium on the final outcome.
 Methods: This prospective study was carried out from March 2021 to December 2021 at Ophthalmolgy Department, Sher-E-Bangla Medical College & Hospital, Barishal. Total 68 patients with different grades of pterygium were operated for pterygium excision with conjunctival autograft and were studied and analyzed. All the eyes underwent detailed ocular examination like visual acuity measured by Snellen’s chart; refractive astigmatism measured by automated keratometry and slit lamp biomicroscopy and fundus examination.
 Results: Pterygium is more common in males (61.76%) than females (38.23%) where 45.59% cases were in age group of 31-40 years followed by 33.82% in 41-50 years and rare (2.94%) in more than 60 years; so, 86.76% cases are in the age group of 31-60 years. Preoperatively mean±SD of K1 (Horizontal meridian) was 42.428±1.853 D and 3 month after the surgery it was 42.061±0.563 D. On the other hand mean±SD of K2 (vertical) readings before surgical excision were 44.185± 0.871 D and postoperatively after 3 months it was 42.691±0.384 D. Pre and post-operative BCVA in Grade I pterygium cases were 6/6-6/9 both pre & post -operatively. In patients of Grade II preoperative VA was 6/18-6/36 which was postoperatively 6/12-6/18; in Grade III pre and postoperative VA was 6/24-6/36 and 6/12-6/18 respectively. While in Grade IV pterygium VA were 6/36-6/60 preoperatively and 6/18-6/24 postoperatively.
 Conclusion: We conclude that, the greater the grade of pterygium the lesser is the outcome of visual acuity after surgery; the greater was the change in keratometry reading. It was inferred that, timely and appropriate surgery at Grade II & Grade III can result in not only a good visual outcome but also less complications.
 J. Natl. Inst. Ophthalmol. 2022; 5(2):25-30

Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study.

Purpose:In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening.Methods:40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye.Results:No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection.Conclusion:Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non-ophthalmologic surgeries.

Changes in Astigmatism and Visual Acuity after Pterygium Excision in the Ashanti Region of Ghana

Background: Pterygium is a conjunctival subepithelial fibrovascular growth commonly occurring in the inter-palpebral conjunctiva nasally or temporally. It tends to grow over the cornea, leading to visual impairment due to various factors, including astigmatism.
 Methods: This was a prospective, multi-centered, hospital-based, interventional study carried out within 12 months in three eye centers in the Ashanti region of Ghana. One hundred eyes of 100 adults (≥18 years) with primary pterygia were recruited. Operated eyes had measurements of uncorrected visual acuity (UVA), aided visual acuity (AVA), and keratometry readings (K-readings) before pterygium excision with conjunctival autograft (CAG), 2 weeks after surgery, and 6 weeks after surgery.
 Results: The mean age of patients was 47.1±11.5 years. The mean pre-operative astigmatism was 5.0±5.9 D. The mean astigmatism values at 2 and 6 weeks post-operatively were 1.7±1.5 and 1.3±1.0 D, respectively. Eighty-nine eyes had AVA ≥6/12 (0.11 mean logMAR) before surgery, whereas 97 eyes had AVA ≥6/12 (0.02 mean logMAR) 6 weeks after surgery, and the increase was statistically significant.
 Conclusion: Pterygia excision with CAG leads to an approximately fourfold reduction in mean pterygium-induced astigmatism by 6 weeks after surgery.

Sutureless and Glue Free Conjunctival Autograft in Pterygium Surgery

Objective: The objective of the study is to report a newer technique of pterygium excision followed by suture less and glue free conjunctival autograft for its complications and recurrence rate. 
 METHODS: This prospective and quassi experimental study was carried out at Baqai medical university hospital, Karachi from January 2016 to December 2016. This study consists of 30 eyes of 22 patients, above 15 years of age with primary progressive Pterygium of 2 mm or more in size and interfering with the vision. All the patients were operated under sub tenon’s anesthesia, Pterygium was excised with surgical blade followed by suture less and glue free conjunctival autograft from superior limbus. Primary outcomes measures included graft loss, granuloma and any other complications noted within six months. Recurrence was also noted at 6 months.
 RESULTS: There were 30 eyes of 22 patients. There were 4 females (18.18%) and 18 male patients (81.81%). The mean age was 31.28 years ± 9.4 SD. Right eye was seen in 16 (53%) cases. Graft lost was recorded in 1 patient (4.5%), conjunctival pyogenic granuloma in 1 patient (4.5%) and graft retraction was seen in 1 (4.5%) case. Recurrence rate was none at 6 months post operatively.
 CONCLUSION: Conjunctival autograft without suture and glue is a new and simple technique that can be done with minimal expenses and limited resources. It has fewer complications and no recurrence.

Cases of toxic anterior segment syndrome after primary pterygium surgery.

Toxic anterior segment syndrome (TASS) is an acute, sterile,inflammatory reaction of the anterior segment afterintraocularsurgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. A case series. Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty wasscheduled for all patients. This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.

Managing Limbal Stem Cell Deficiency with Simple Limbal Epithelial Transplantation – Perspective and Practical Guide

Limbal stem cell deficiency (LSCD) is an important cause of blindness. Various etiological factors can cause this challenging disease and several ocular and systemic comorbidities often make the management challenging in these cases. Limbal stem cell transplantation (LSCT) is the gold standard treatment for LSCD. Various techniques of LSCT such as conjunctival limbal autograft and cultured limbal epithelial transplantation have been described to treat this condition. Simple limbal epithelial transplantation (SLET) is an innovative technique of LSCT that has established itself as a successful modality for treating LSCD while addressing limitations of other procedures such as cost, reach and replicability. This review attempts to present a detailed account of SLET comprising of case selection criteria, surgical procedure, post operative care and complications and comparative details of the various techniques of LSCT. We also discuss pertinent tips related to the procedure which we hope will be beneficial for both beginner surgeons and those already practicing SLET.

A Comparative Study of Conjunctival Autografting after Pterygium Excision with Autologous Blood Coagulum and Sutures

A Comparative Study of Conjunctival Autografting after Pterygium Excision with Autologous Blood Coagulum and Sutures

Evaluation of the Efficacy of Different Pterygium Surgeries in Polish Caucasian Population.

The aim of the study was to compare the efficacy of the two most commonly used surgical methods for pterygium removal in the Polish population, conjunctival autograft versus amniotic membrane transplantation, and to evaluate the postoperative recurrence rate. A retrospective analysis of the medical records was conducted, including 65 patients who underwent surgery for primary or recurrent pterygium at an ophthalmology clinic in Bialystok, Poland, between 2016 and 2020. Surgical success (no regrowth) was achieved in almost half of the amniotic membrane patients (44%) and in most of the conjunctival autograft patients (79%), with statistical significance. The odds of successful surgery were 79% lower for subjects with amniotic membranes than for those with conjunctival autografts (OR with 95% CI = 0.21 (0.05; 0.94); p=0.045). Our study confirms that the conjunctival autograft surgeries present more favorable success rates in Polish Caucasian population when compared to procedures involving amniotic membranes.

Α Novel Sutureless Pterygium Excision Surgery Using Human-Derived Dehydrated Amniotic Membrane

There are many surgical techniques available for the management of pterygium. Excision with limbal conjunctival autograft is currently the most popular surgical procedure and has been shown to have low recurrence rate and fewer complications. The fixation of limbal conjunctival autograft is performed with either sutures or fibrin glue. The use of sutures results in longer operating time and intense postoperative irritation and epiphora. We describe a new technique for pterygium excision using a human amniotic membrane-derived dry matrix (Omnigen®; Nottingham, UK: Nu-Vision Biotherapies). The use of Omnigen instead of conjunctival autograft in pterygium surgery is a new promising technique and results in shorter operation time, easier graft fixation, reduction in complications, and less postoperative discomfort. This is a simple technique for pterygium surgery with dry amniotic membrane matrix and without the need for anchoring limbal sutures or an assistant holding the graft whilst it is glued in place.

A Comparative Study between Sutureless, Glue-less Conjunctival Autograft vs Sutured Limbal Conjunctival Autograft for Primary Pterygium

A Comparative Study between Sutureless, Glue-less Conjunctival Autograft vs Sutured Limbal Conjunctival Autograft for Primary Pterygium

Pilot study of a glue-less, suture-less amniotic membranefor pterygium excision.

Pterygium is a non-cancerous, fibrovascular growth of the bulbar conjunctiva that can cause visual disturbance, ocular pain, and cosmetic concerns. Surgical management is required in certain cases, which consists of excising the pterygium and associated Tenon's, then overlaying the bare sclera with an autograft or amniotic membrane using glue or sutures. The purpose of this study is to assess outcomes of pterygium repair using a newly developed self-adhesive amniotic membrane that does not require glue or sutures for fixation. Chart review of pterygium excision using a new self-adhesive amniotic membrane from a single surgical practice from 2012-2018. Descriptive statistics from 51 primary cases of pterygium excision were included. Pterygium recurrence occurred in 3 of the 51 self-adhesive amniotic membrane cases studied, resulting in a recurrence rate of 5.9%. Pterygium excision with the self-adhesive amniotic membrane had high rate of pyogenic granuloma formation of 27%. Self-adhesive amniotic membranes were found to perform comparably to more widely used techniques for pterygium excision, namely amniotic membranes and conjunctival autographs with glue or sutures. However, the self-adhesive grafts are associated with substantially more pyogenic granuloma formation. Self-adhesive amniotic membranes offer comparable efficacy for preventing pterygium recurrence in comparison to other amniotic membranes and the conjunctival autograft. The incidence of pyogenic granuloma formation is higher in self-adhesive grafts compared to other widely used options.

Comparison of Pterygium Recurrence with and Without Using Postsurgical Topical Cyclosporin a 0.05%

Purpose:To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery.Methods:In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared.Results:The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99).Conclusion:The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

Donor graft harvesting with air in pterygium surgery.

Report a new technique for improvement of pterygium surgery: donor graft harvesting with air. We describe a technique that was used with 138 patients who underwent surgery that included a conjunctival autograft and fibrin glue with air injection to dissect the Tenon capsule from the conjunctiva. No complications occurred with this technique and all patients achieved good results. The surgical time with this new technique was similar to that reported in the literature. In addition, the graft thickness was close to that reported with femtosecond laser dissection and it was thinner than that reported with aesthetic/saline dissection (unable to determine statistical significance). With the injection of an air bubble, we could easily dissect the conjunctiva from the Tenon capsule and quickly acquire thin grafts without any additional costs or complications.

Pterygium surgery with conjunctival limbal autograft in an eye clinic from Villavicencio, Colombia

Objective: To describe results of pterygium surgery at Clínica de Cirurgía Ocular Villavicencio, in Meta, Colombia. Methods: A retrospective analysis of pterygium surgeries performed between January 2017 and December 2019. Results: Approximately 1,200 records were reviewed, and 1,200 procedures included. The most frequent complications were corneal Dellen, pterygium recurrence, graft retraction and pyogenic granuloma (7.5%, 2.5%, 3% and 0.75% respectively). These were identified within the first 6 months of surgery. Conclusion: Pterygium surgery using conjunctival autografts is an effective [...]

A clinical study to evaluate recurrence of pterygium after primary surgery and its management

Recurrence is a significant problem after pterygium excision. Therefore in this study its risk factors and management is discussed. This study was conducted to observe recurrence after conjunctival limbal autograft (CLAU) & to evaluate different factors related with recurrence of pterygium and assessing its different management methods. Hundred & seven patients with primary pterygium were examined, excised by CLAU and histopathology sample sent. The outcomes were assessed in terms of clinically significant recurrence till 6 months follow-up. Early topical mitomycin-C (MMC) 0.02% QID for a week was given to avoid resurgence of clinically significant pterygium, however if developed then excised by CLAU (if <4mm) or AMG (Amniotic membrane grafting) (if > 4mm). Out of total cases, 57% were females. Histopathology findings includeEpithelial Hyperplasia (80.4%), vascularity overwhelms fibrosis (39.1%), vascularity similar to fibrosis (28.3%), fibrosis overwhelms vascularity (34.8%), perivascular stromal inflammation (54.3%), diffuse stromal inflammation (37.0%). The following variables were significantly associated (p<0.05) with the recurrence: age, redness & thickness, higher vascularity, diffuse inflammation. Factors such as younger age group, higher redness and thickness of pterygium, more vascularity, and diffuse inflammation on histopathological examination can be considered as a risk factor for recurrence. However, occupation, location, and type of pterygium were found not to be related to recurrence. Although no clinically significant recurrence was seen after mitomycin c eyedrops, but no significant correlation can be made. Young patients having pre-operative features like red and fleshy pterygium, along with vascularity more than fibrosis and diffuse inflammation on histopathological examination should be followed strictly and managed intensely.

Evaluation of Sutureless Glueless Conjunctival Autograft in Pterygium Surgery

Evaluation of Sutureless Glueless Conjunctival Autograft in Pterygium Surgery

Recurrent ligneous conjunctivitis after cataract surgery in a 67-year-old male patient: a case report

BackgroundLigneous conjunctivitis is a rare form of chronic pseudomembranous conjunctivitis which usually starts during infancy. We report on an unsual case of recurrent ligneous conjunctivitis after cataract surgery in a 67-year-old male patient.MethodsThe equipment used for the slit-lamp images was a Haag Streit slit lamp BX900 Sn 00,406 with 16 × magnifications. The used batch number of the camera was sn00406 and the software was from the company CCS Pawlowski Merge Eye. There were no filters used. The images were saved with a resolution of 300 DPI. Neither downstream nor averaging was used to enhance the resolution of the image in the case presentation section or the figure legend.The equipment used for the cross-sectional histologic images was a Zeiss Axioskop 40 microscope with an objective lens Zeiss A-Plan × 20/0.45 (Zoom 6.3 × TV 2/3″″C). The used camera was AxioCam MRc5 and the software was ZEN 3.2. The cross-sectional histologic images were saved with a resolution of 2584 × 1936 Pixels. Neither downstream nor averaging was used to enhance the resolution of the image in the case presentation section or the figure legend.Case presentationThis is a rare case report of ligneous conjunctivitis in a 67-year-old male patient who presented a recurrent conjunctival granuloma after five excisions following cataract surgery in his left eye. We performed a tumor excision with free conjunctival autograft. The histology showed a fibrin crust including macrophages, granulocytes, lymphocytes, and reactively altered squamous cell nests. These findings were consistent with a ″pseudomembrane in conjunctivitis lignosa″. We administered a topical combination of plasminactivator, heparin, cortisone and cyclosporine.ConclusionThis treatment with the combination of plasminactivator, heparin, cortisone and cyclosporine has proven to be effective in preventing the recurrence of ligneous conjunctivitis.

Inferior Conjunctival Autograft Transplantation for Primary Pterygium

Objective: To evaluate postoperative recurrence rate and complications after inferior conjunctival autograft transplantation for primary pterygium. Materials and Methods: The present study was a retrospective Cohort study on 45 eyes in 45 patients that underwent inferior conjunctival autograft transplantation after pterygium removal in primary pterygium. The results of all patients were reviewed. The success rate was determined in terms of recurrence rate of pterygium. Postoperative complications were also analyzed. Results: The present study comprised 45 patients for 45 eyes, that undergone inferior conjunctival autograft transplantation after pterygium removal in primary pterygium. The mean follow-up was 14.2±10.1 months. Recurrence rate was 7% or three eyes, in one year follow-up. No serious complications were found. Conjunctival buttonhole was a major complication. Conclusion: Inferior conjunctival autograft transplantation after pterygium removal is an effective and safe treatment with low complications. This alternative surgical technique is used to preserve superior conjunctiva for future glaucoma filtering surgery. Keywords: Inferior conjunctival autograft; Primary pterygium; Glaucoma