Conjunctival Limbal Autograft Research Articles

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note.

To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation. Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability. Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min vs 18.15±2.20min, P=0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) vs 3.00min (2.21-4.15), P<0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (P<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) vs 2 (1-4), P<0.001]. Postoperative symptoms at 6mo were comparable between the groups (P=0.487), with no recurrence. ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.

Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties.

To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.

Conventional Pterygium Excision with Conjunctival–Limbal Autograft Compared with Supra-Tenon Excision of Pterygium Along with Small Limbal Autograft

ABSTRACT Context: New pterygium surgery methods have been developed over the years because recurrence is high (30–70%) after simple excision. Aims: To compare the surgical time, ocular discomfort score, and recurrence rate in conventional pterygium surgery, where excision of pterygium and Tenon’s capsule is performed and the area is covered using conjunctival–limbal autograft (CLAU) with supra-Tenon excision of pterygium (STEP) along with small limbal autograft in patients with primary pterygium. Settings and Design: A Prospective comparative study was conducted at a rural medical college–hospital from November 1, 2017, to October 31, 2019, among 110 participants after ethical approval from Institutional Ethics Committee. Materials and Methods: All participants had primary pterygium of grades I and II depending on corneal encroachment and Tan’s stages T1 and T2 morphologically. Fifty-five underwent conventional surgery with CLAU (group A), and STEP with small limbal autograft (group B) was performed in the remaining fifty-five. The follow-up period was one year. The ocular problem, comfort of subject, recurrence, or other complications were documented, and statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) software version 21. Results: The mean surgical time was significantly less in group B (38.79 vs. 42.04 minutes) (Z = 11.38, P = 0.001 with confidence interval 10.81–13.38) and ocular discomfort score (ODS) was lower in group B as compared with group A (P &lt; 0.05). Group B had two eyes with recurrence, though not statistically significant (P = 0.49). Conclusion: STEP with small limbal autograft is worth consideration for primary pterygium management.

Study of biomarkers p53, Ki-67, Bcl-2, and VEGF in pterygium.

To study the biomarkers present in primary pterygium samples of patients of Indian ethnicity and compare it with the samples obtained from the unaffected conjunctiva of the same eye. A prospective case-control study of 17 eyes in patients above 10 years of age with primary pterygium who underwent pterygium excision using limbal conjunctival autograft technique. The pterygium samples (cases) and conjunctival samples (controls) were sent for immunohistochemical (IHC) staining for the following biomarkers: p53, Bcl-2, Ki-67, and vascular endothelial growth factor (VEGF). The immunohistochemistry of the samples and the controls revealed p53 positivity in 47.05% of pterygium samples and 29.4% of controls ( P < 0.587). Nine cases each in pterygium and control samples were positive for Ki-67 expression. Differences in the staining pattern between the two groups were not statistically significant ( P < 1.000). Bcl-2 positivity was seen in 10 pterygium samples (58.8%) and 12 controls (70.5%), with no statistical difference between the two groups ( P < 0.455). VEGF expression was seen in both epithelial and endothelial cells of the samples and controls, with no statistical difference between the two groups, with P = 1.000 for the epithelial staining and P = 0.637 for endothelial staining. The expression of biomarkers was comparable in both groups. We conclude that pterygium, against common belief, might not be a localized disease process but a global ocular phenomenon where the apparently healthy tissue also has some ongoing disease process at a molecular level.

Efficacy of Subconjunctival Bevacizumab Injection after Pterygium Excision with Limbal Conjunctival Autograft in Recurred Pterygium

Purpose: To evaluate the efficacy and safety of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture in recurred pterygium.Methods: We retrospectively reviewed the medical records of 9 patients (11 eyes) who received subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture for recurred pterygium. All patients included in this study completed follow-up for at least 12 months. Demographic variables, postoperative clinical outcomes, and recurrence rate were analyzed. Recurrence of pterygium was evaluated at 12 months after surgery.Results: The study subjects comprised 5 male patients (5 eyes) and 4 female patients (6 eyes) with a mean age of 66.0 ± 13.0 years (range 43-78 years). Among the 11 eyes, no recurrence occurred after the follow-up period of 12 months.Conclusions: Subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture appears to be an effective method of preventing the recurrence in recurred pterygium.

Evaluating surgical outcome of pterygium excision with conjunctival autograft using autologous blood: Can it be a new norm?

To evaluate the surgical outcome of use of autologous blood as an adhesive agent in pterygium excision with conjunctival auto-grafting. To observe the effectiveness of autologous blood adherence on the scleral bed and to know whether autologous blood technique can be made as a standard procedure in pterygium surgery or not.The present study is a retrospective observational study. The records of 94 cases of primary pterygium surgery done during August 2022- January 2023 were taken. All patients underwent comprehensive ocular examination pertinent to the disease. Pterygium was dissected and remaining subconjunctival pterygium tissue was separated and excised. The conjunctival limbal auto-graft was taken secured in place by autologous blood and dressing done. Follow-up was done on second post operative day,1st week and 1 month. The study displayed excellent surgical outcome with minimal post operative complications, which too resolved in a week. The most common complication was subconjunctival hemorrhage in 38 cases followed by graft edema in 32 cases. Though graft displacement was observed in 4 cases, they were later rearranged successfully. We did not observe even a single graft loss in our study.Pterygium excision with conjunctival auto-grafting with autologous blood is very safe, less time consuming, easy to perform with less learning curve, economical with excellent postoperative outcome and most importantly more patient satisfaction, thus, making it equivalent to or rather superior to other comparable procedures.

Comparative Assessment of Mitomycin C versus Limbal Conjunctival Autograft for Primary Pterygium Removal: An Evaluation of Efficacy

Objective: This study aims to evaluate and contrast the outcomes achieved by application of mitomycin C 0.02% intra-operatively versus employing limbal conjunctival autograft after the removal of primary pterygium. Study Design: Randomized controlled trial (RCT) Place and duration: The research was carried out at the Ophthalmology Department of Ghazi Hospital in Dera Ghazi Khan, spanning from October 2021 to September 2022. Methodology: The research included 62 participants who were divided into two groups; one group receiving Mitomycin C and the other group underwent limbal conjunctival autograft. The main variables assessed in the study were the laterality of pterygium, size of pterygium extending over the limbus, preoperative and postoperative best corrected visual acuity, and the rate of pterygium recurrence in both groups. The analysis of data was conducted utilizing SPSS version 24. Results: In Group MMC, 48.4% of patients showed right laterality, while in Group LCAU, 58.1% (p=0.445) showed it. The average size of pterygium crossing the limbus, as well as preoperative and postoperative best corrected visual acuity, were similar between both groups (p&gt;0.050). Regarding recurrences, the percentages at 3, 6, and 9 months, as well as after 1 year, were higher in Group MMC (12.9%, 6.5%, 16.1%, 9.7%, 45.2%) compared to Group LCAU (9.7%, 9.7%, 3.2%, 6.5%, 29%), but these differences were not statistically significant (p=0.526). Conclusion: Limbal conjunctival autograft appears to be more effective in preventing recurrence following the excision of primary pterygium compared to intraoperative application of Mitomycin C. However, both techniques, whether simple excision with LCAU or MMC application, demonstrate acceptable outcomes with only minor differences in recurrence rates. Surgeon expertise and preferences in local practice play significant roles as main risk factors influencing the choice between these two methods.

Anterior Segment Optical Coherence Tomography Study of Pterygium in Conjunctival - Limbal Autograft Transplantation

&#x0D; Introduction: Progressive, gradual, non-malignant proliferation of fibro-vascular tissue, occurring due to repetitive limbal stem-cell irritation &amp; neovascularization, is referred to as pterygium. It is widespread in equatorial regions of the world, with a prevalence of 22% over a well defined ‘pterygium belt’. pterygium excision leaving bare sclera leads to the re occurrence, where as supplementing bare sclera with conjunctival autograft reduces the recurrence up-to 6%. Objective: Assessment of pterygium thickness pre-operative ly &amp; post-surgery keratectomy area along with graft thickness after conjunctival limbal autograft transplantation (CLAT) surgery by anterior segment optical coherence tomography (AS- OCT). Method: 50 patients with primary pterygium were distributed age wise in 4 groups of 20-39, 40-59, 60-79 &amp; 80-99 years. Anterior segment imaging was performed with RT-vue spectral domain AS-OCT. pterygium thickness pre-operatively &amp; keratectomy area along with autograft thickness after CLAT surgery was evaluated for a follow-up period of 3 months. Results: the pre-op pterygium &amp; 3 months post-op keratectomy area thickness at apex for (group 1) were 854um &amp; 573um, (group 2) were 855um &amp; 578um, (group 3) were 859um &amp; 574um and (group 4) were 868um &amp; 575um. Similarly at limbus for (group 1) are 1.13um &amp; 720um, for (group 2) are 1.14um &amp; 725um, for (group 3) are 1.19um &amp; 718um, for (group 4) are 1.24um &amp; 714um. Reduction in graft thickness in 3 months follow period for (group 1) was 311um, (group 2) 304um, (group3) 303um &amp; (group 4) 313um respectively. Conclusions: CLAT ascertains to be the ideal treatment modality for pterygium management in terms of decreasing the complications &amp; recurrence rate. Also, AS-OCT is the optimal investigating modality in assessment of pterygium before &amp; after CLAT surgery.

A COMPARATIVE STUDY TO EVALUATE THE CLINICAL OUTCOME OF CONJUNCTIVAL LIMBAL AUTOGRAFT AND AMNIOTIC MEMBRANE TRANSPLANT FOR THE TREATMENT OF PRIMARY PTERYGIUM

Aim: The aim of the study was to assess the safety and effectiveness of the conjunctival limbal autograft (CLAG) and amniotic membrane transplantation (AMT). Methods: After a full pre-operative assessment 100 patients with primary pterygium attending the ophthalmology outpatient department of a teaching hospital in Eastern India, fulfilling the inclusion and exclusion criteria were selected for our study. The patients were explained the procedure of the study and possible outcomes. They were divided into two groups. Group A: Where 10-0 nylon was to be used for CLAG after pterygium excision. Group B: Where 10-0 nylon was to be used for AMT after pterygium excision. Results: There was marked improvement in vision postoperatively more in the AMT group than CLAG. In the AMT group: 34% had a visual acuity of LogMAR 0.00, 30% had LogMAR 0.12, 12% had LogMAR 0.18, and 24% had LogMAR 0.30 after the surgery. In the CLAG group: 52% had a visual acuity of LogMAR, 20% had LogMAR 0.12, 22% had LogMAR 0.18, and 6% had LogMAR 0.30 after the surgery. Graft and suture-related complications were more in the CLAG group than in the amniotic membrane (AM) graft group. Conclusion: In the present study, The CLAG group was found to be associated with more discomfort, and more post-operative complications than AMT. AM may provide a basement membrane rich in various growth factors and matrix proteins, which promotes epithelial cell migration, adhesion, and differentiation. It is also believed to have anti-inflammatory and antifibrotic effects and exerts anti-scarring effects through the transforming growth factor-β pathway. AMT may be a superior treatment in primary pterygium due to lower recurrence rate, shorter surgical times, and better visual and cosmetic outcomes.

Conjunctival Limbal Autograft Combined with Amnion-Assisted Conjunctival Epithelial Redirection for Unilateral Total Limbal Stem Cell Deficiency after Severe Chemical Burn.

(1) Background: To evaluate the efficacy of conjunctival limbal autograft (CLAU) combined with the amnion-assisted conjunctival epithelial redirection (ACER) procedure for patients with unilateral total limbal stem cell deficiency (LSCD) caused by severe chemical burn. (2) Methods: A retrospective interventional case series of unilateral total LSCD after chemical burn who underwent CLAU combined with ACER surgery between September 2021 and July 2023 was collected. Outcome measures included epithelialization of the cornea with donor limbus-derived epithelium, best corrected visual acuity (BCVA), and complications. (3) Results: Nine males and one female were included in this study. The mean age was 40.9 ± 9.63 (range, 26 to 55) years. The average duration between injury and CLAU combined with the ACER procedure was 7.67 ± 3.97 (range, 4 to 18) months. All patients achieved corneal epithelialization and improved BCVA. Postoperative complications occurred in four cases, including delayed corneal epithelial healing in one case, delayed amniotic membrane dissolution and detachment in two cases, and recurrence of symblepharon in one case. No complications were noted in the healthy donor eyes. (4) Conclusions: CLAU combined with ACER is a safe and effective treatment for unilateral total LSCD caused by severe chemical burn. This combined surgery restores visual function for patients with corneal blindness caused by chemical burn, reducing the burden on the families and society.

Comparison of mini-simple limbal epithelial transplantation and conjunctival–limbal autograft for the treatment of primary pterygium: a randomised controlled trial

PurposeThe purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival–limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision...

The effect of different pterygium surgery techniques on the ocular surface parameters in different durations: a systematic review and meta-analysis.

To evaluate the effects of different pterygium surgery techniques on ocular surface (OS) in different follow-up periods. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and China Biology Medicine disc were searched for studies reporting pre- and post-operative OS parameters in pterygium. A total of 33 articles were finally included. Three OS parameters showed relatively consistent changing trends after surgery including ocular surface disease index (OSDI), tear film break-up time (BUT), and score of corneal fluorescein staining (SCFS). They worsened significantly at 1w post-operation and then gradually improved: OSDI and BUT showed obvious improvement in 1m post-operation (SMD = - 0.58, 95%CI = [- 1.04, - 0.13]; SMD = 0.42, 95%CI = [0.06, 0.78]); SCFS was restored to preoperative levels in 3m after surgery (SMD = - 0.54, 95%CI = [- 1.16, 0.07]). Another parameter, Schirmer test without anesthesia (SIT), presented transient increase at 1w post-operation (SMD = 0.87, 95%CI = [0.27, 1.47]) and presented a relatively stable improvement after 1m post-operation (SMD = 0.52, 95%CI = [0.16, 0.89]). All parameters in amniotic membrane graft (AMT) showed better improvement in early stage and they showed non-inferior improvements in the long term compared with conjunctival autograft (CAG). Limbal-conjunctival autograft (LCAG) made excellent improvement to OS in the long term while pterygium excision (PE) showed the worst OS. The type of pterygium (primary and secondary), diabetes mellitus (DM) status, and fixation method had certain effects on the results. OS of pterygium is deteriorated at 1w post-operation then gradually improved to preoperative levels after 1m post-operation. Among various surgery techniques, LCAG had the best improvement to OS which especially displayed in the long-term outcomes.

Modified Limbal-Conjunctival Autograft Surgical Technique: Long-Term Results of Recurrence and Complications.

The aim of this study was to report the recurrence and complication rates of a modified limbal-conjunctival autograft surgical technique for pterygium excision. This was a retrospective, single-surgeon, single-operating environment, consecutive case series of 176 eyes in 163 patients with a biopsy-proven diagnosis of pterygium. All patients underwent excision using a 23-gauge needle to "behead" the pterygium head, followed by a limbal-conjunctival autograft including ∼50% of the palisades of Vogt. Outcomes measured included recurrence, defined as any conjunctival fibrovascular growth, and complication rates. Correlations between preoperative patient characteristics, pterygium morphology, and intraoperative factors (width of corneal extension, conjunctival defect, and graft) with postoperative recurrence were examined using logistic regression models. The median age was 59.5 years and 122 eyes (69.3%) had primary pterygium (type I: 17%, II: 37.5%, and III: 45.5%). Kaplan-Meier analysis demonstrated the median pterygium-free follow-up period to be 723 days (range 46-7230 days). Recurrence was observed in 3 eyes of 2 patients (1.7%). No postoperative graft-related complications were observed. Postoperative symptomatology was transient. Age demonstrated a negative correlation with recurrence (odds ratio 0.888, 95% CI, 0.789-0.998, P = 0.046). However, no other correlations with preoperative or intraoperative factors, including whether pterygium was primary or recurrent, were identified (all P > 0.05). This modified limbal-conjunctival autograft technique represents an effective alternative that offers a very low recurrence rate and avoids extensive dissection or antimetabolites, with minimal complications and transient postoperative symptomatology, over a long-term follow-up period. This technique is relatively simple and successful for both primary and recurrent pterygia. Future comparative studies with other surgical techniques may determine which are superior.

Comparison of the outcome of 0.02% mitomycine C versus limbal conjunctival autograft after primary pterygium excision.

Objective: is to compare the outcomes of mitomycin 0.02% intra-operatively and limbal conjunctival autograft after excision of primary pterygium. Methodology: Randomized controlled trial (RCT) was conducted at Opthalmology department Shalamar medical and Dental College, Lahore from October 2021 to September 2022 in duration of 1 year. A total of 62 patients enrolled in study. Patients were divided into two groups MMC and LCAG. Main variables of study were laterality of pterygium, size of pterygium cross limbus, preoperative and post operative BCVA and proportion of pterygium recurrence in both groups. SPSS version 24 was used for data analysis. Results: Laterality were right for 48.4% patients in Group MMC and 58.1% for Group LCAG, (p=0.445). The average Size of pterygium cross limbus, Preoperative and postoperative BCVA of both the groups were almost equal, (p&gt;0.050). The recurrences at 3, 6 &amp; 9 months and after 1 year in Group MMC was 12.9%, 6.5%, 16.1%, 9.7%, 45.2% which is greater than Group LCAG 9.7%, 9.7%, 3.2%, 6.5%, 29% respectively, but the difference was statistically insignificant, (p=0.526). Conclusion: Limbal conjunctival autograft is more successful in prevention of recurrence after excision of primary pterygium as compare intraoperative application of mitomycin-c. But simple excision and LCAG or MMC both are acceptable in terms of minor difference in recurrence rate, surgeon’s skill and preferences of local practice are main risk factors.

Novel limbal dermoid surgery for visual acuity and cosmesis improvement: A 7-year retrospective review.

To report a long-term outcome of the novel combined surgical method of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft for limbal dermoid. All patients who were referred to our clinic for limbal dermoid, and underwent a combined surgery of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft were retrospectively reviewed. The surgery was performed by one surgeon, and all clinical information was obtained during a seven-year follow up period. In all patients, surgical outcomes of cosmesis, best corrected visual acuity (BCVA), spherical equivalent (SE), and corneal/ocular astigmatism were obtained and compared preoperatively and postoperatively. During seven years, 24 patients (24 eyes) with limbal dermoid were finally enrolled. The mean age was 10.1±8.9 years old. The surgery resulted in an improved appearing ocular surface in all cases without any complications. There was no statistical difference in BCVA, corneal and ocular astigmatism between preoperatively and postoperatively (p = 0.231, 0.156 and 0.475, respectively). The mean SE was 0.12±3.19D preoperatively, and -0.21±3.02 D postoperatively with statistical significance (p = 0.037). Mean follow up period was 54.50 ± 15.62 months. Based on the results of this study, our innovative surgical method which includes complete excision with corneal tattooing and limbal conjunctival autograft can be a simple and safe procedure that achieves long standing cosmesis with limbal dermoids.

Suture and glue-free autologous graft for pterygium surgery

Of various techniques of pteryium surgeries to prevent recurrence, conjunctival limbal auto graft has been the most successful adjuvant since the studies have shown the role of limbal stem cell deficiency (LSCD) as pathology of pterygium. The most common method of auto-graft fixation post pterygium excision is suturing; with drawbacks of prolonged operating time and postoperative discomfort. Replacing sutures with tissue adhesives may shorten the operating time, improve postoperative comfort; however, the major concern of the commercial fibrin glue is the cost and the potential risk of transmission of infection.To study, 1. The efficacy and complications of suture free and glue free conjunctival-limbal auto-graft for the management of pterygia, 2. The outcome of surgeries by two different qualified surgeons Prospective, interventional case study of 108 consecutive cases of pterygia that had excision with conjunctival-limbal auto-grafting without using glue or sutures. The operated eye patched for a day and followed up on day 1, 3 and 7, 6 weeks and 6 months; watched for hemorrhage beneath the graft, graft retraction, chemosis, recurrence or any other complication. The mean age of the patients was 40.7 years (range, 25 – 68 years) with female preponderance (60.2%) and nasal pterygia in 65.7 %. Not a single graft was dislodged and none had recurrence in the follow up period of 9-20 months. Graft retraction occurred in 7 cases (6.5%) and one patient had sub-graft hemorrhage which lasted for nine days. 76.9% had no discomfort even in immediate post-operative period. The results were comparable among patients of both the surgeons.Suture- and glue-freelimbal conjunctival auto-grafting following pterygium excision is a safe, effective and economical option for the management of both primary and recurrent pterygium. Learning curve is short and consistently similar results possible in different hands.

A STUDY ON EFFECT OF PTERYGIUM EXCISSION ON PTERYGIUM INDUCED ASTIGMATISM

Purpose: Methods: To determine the effect of pterygium excision on pterygium induced astigmatism. A statistical comparison of the refractive astigmatism before and after effective pterygium surgery was done on 30 patients who underwent preoperative and postoperative refraction testing. pterygium surgery caused si Results: gnicant improvements in visual acuity, with the rule astigmatism. The corneal astigmatism tended to decrease s Conclusion: ignicantly following pterygium excision with conjunctival limbal autograft transplantation.

Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review.

The purpose of this study is to compare the "real-life" effectiveness of amniotic membrane graft (AMG) and conjunctival (CAT) or limbal conjunctival (LCA) autograft in the management of primary pterygium. Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured. 35 real-life retrospective subgroups comprising a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were less common for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6.03% and 23.0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%). AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence.

Topical cyclosporine A and interferon alpha-2b as adjuvants to surgery to decrease pterygium recurrence.

Pterygium is very common in India and is usually removed by limbal conjunctival autograft transplantation (LCAT), which, despite being the first-line therapy, is still associated with recurrences of up to 18%. To compare the safety and efficacy of topical cyclosporine A (CsA) and interferon (IFN) alpha-2b in the prevention of postoperative recurrence of pterygium. A total of 40 patients with primary pterygium were randomized into two equal groups, Group C and Group I. Both the groups underwent LCAT, with Group C kept on topical cyclosporine 0.05% (CsA) 4 times daily and Group I on topical IFN alpha 2b 0.2 million IU 4 times daily postoperatively for 3 months. Pre- and posttreatment best-corrected visual acuity (BCVA), recurrence, and complications were assessed at day 1, week 1, 1 month, and 3 months. The mean preoperative BCVA of 0.51 ± 0.18 and 0.51 ± 0.23 improved to 0.13 ± 0.13 and 0.13 ± 0.13 in Group C and Group I, respectively, after 3 months of treatment (P < 0.0001). Recurrence was seen in 2 cases in Group C and in 1 case in Group I at 3 months. No significant complications occurred in either of the groups. Topical CsA and IFN Alpha-2b are newer efficacious adjuvants with LCAT for prevention of postoperative pterygium recurrence.

A prospective observational study on the effectiveness of pterygium excision with limbal conjunctival autograft transplantation and recurrence in patients of primary pterygium

Background: Pterygium is a degenerative and hyperplastic process with abnormal fibrovascular proliferation. Surgery is the treatment of choice in progressive or symptomatic cases but recurrence is a concern. Aims and Objective: We aim to evaluate the effectiveness of pterygium excision and conjunctival autograft (done by post-graduate trainees in the 2nd and 3rd year of residency under supervision) and recurrence of this process in a tertiary care setup. Materials and Methods: It is a single-centric prospective observational study. 50 patients who underwent pterygium excision with conjunctival autografting surgery in a tertiary care hospital were followed up for 1 year. Patients were evaluated on day 1, day 7, 1 month, 6 months, and 1 year. Efficacy and graft stability were assessed on day 7 and 1 month; 6 months and 1 year for recurrence and the factors associated with it. Results: Total number of patients was 50; 31 were female, and 19 were male. All cases were effectively managed with excision and autograft. Post-operatively, 13 (26%) patients had shown suture loosening, 17 (34%) patients had graft edema, and 13 (26%) patients had post-operative recurrence. Out of 13 patients, 8 patients had mild recurrence, 4 patients had moderate recurrence, and 1 patient had severe recurrence. Graft stability is significantly associated with suture loosening (P &lt; 0.05). There is no association between the extent and grade of pterygium (P &gt; 0.05). Recurrence was statistically highly associated with (P &lt; 0.0001) suture loosening. Conclusion: We conclude that autografting is an effective technique. Intraoperative proper suturing technique and minimal tissue manipulation can minimize recurrence.