Conjunctival Rotation Research Articles

Plasma technology instead of suture and glue in pterygium removal surgery with conjunctival rotational flap; A 1 year follow up Case report

Purpose: To introduce a novel technique using PANIS method (Plasma assisted noninvasive surgery) in pterygium removal surgery with conjunctival rotation flap. Methods: Two patients (1 male, 1 Female) with grade 3 and 4 of pterygium, based on SLIT2 grading system, underwent surgery with local anesthesia, removing pterygium tissue from cornea and also all related subtenon. Then surgeon used residual conjunctiva to cover bare sclera using rotational method. Fusion of the border of conjunctival flaps from nasal to superior occurred by plasma spots. UCVA, BCVA, OSDI and patient satisfaction were evaluated before, 1 month, 6 months and 1 year after the surgery, as well as 1 day and 1 week post-operation examinations included slit-lamp and external check-up that has been done by the surgeon. Results: Patients with primary pterygium, underwent surgery with PANIS method. Last follow-up session in 1 year, showed significant improvement in astigmatism and 1 line in BCVA. There were no complications and side effects during and after the surgery and also other reported complication included diplopia in lateral gaze, granuloma and scarring was not observed and no recurrence have been seen in the follow-up period and patients were satisfied. Additionally 1 day and 1 week slit-lamp examination showed plasma spots caused good attachment of conjunctival tissue with ocular surface. Conclusion: After treating 2 patients with PANIS method, it seems that plasma spots can be a good substitute for suture or glue in pterygium surgery with conjunctival rotational flap, because it's easy and fast way for fusing the conjunctival flap without any complication or side effect.

Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

BACKGROUND: Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. A prospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. RESULT: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatement of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. CONCLUSION: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft..

Surgical outcome of conjunctival rotational autograft-mitomycin C (MMC) versus free conjunctival autograft-MMC for pterygium removal: A randomized clinical trial.

BackgroundPterygium is a common degenerative eye disease. Despite various surgical methods to treat pterygium, recurrence is the main complication. The main issue is finding a surgical method with the lowest recurrence.Objectiveto compare the complications, recurrence rate and the cosmetic effects of two surgical techniques, namely conjunctival rotation autograft (CRA) and conjunctival autograft (CA), in treating pterygium.MethodsThis randomized clinical trial was conducted at Khalili Hospital in Shiraz, Iran, from January to August 2015. Forty-five eyes from 45 patients were studied. The patients were randomly divided into two groups using the blocking method. The patients of one group were operated on by the CRA technique, while the other group was operated on by the CA method. The patients were checked for the recurrence of pterygium, and other complications at the end of the first, third, and sixth month. Finally, the data were analyzed using SPSS version 21.ResultsThe mean age of the patients was 42.5 years. The recurrence of pterygium was not observed in any of the patients 6 months after the surgery. Following 6 months after the operation, graft retraction occurred during the first week for one patient (4.5%) in the CA group, and five patients (21.7%) in the CRA group. The prevalence rate of graft injection among the patients of the CA and CRA groups 6 months after the operation was 9.1% and 65.2%, respectively. There was a significant correlation between injection intensity and the dissatisfaction of the patients with the operation’s outcome (p=0.017).ConclusionCRA with mitomycin is considered as an effective method to reduce the recurrence of pterygium after operation. This technique can be used as an acceptable method for pterygium operation, especially for patients with insufficient conjunctiva.Clinical trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016092119581N2.FundingThe study was financially supported by Shiraz University of Medical Sciences (SUMS) (grants No. 8901).

Low recurrence rate of anchored conjunctival rotation flap technique in pterygium surgery

BackgroundTo report the recurrence rate for an anchored conjunctival rotation flap technique in primary pterygium surgery.MethodsPrimary pterygium surgeries performed using anchored conjunctival rotation flap techniques (110 eyes in 110 patients) with a minimum follow-up of 12 months were reviewed. In this technique, a conjunctival flap is rotated to cover the bare sclera and suture-fixated with either 8–0 polyglactin (41 eyes) or 10–0 nylon (69 eyes). The recurrence rate was determined, and the two suture materials utilized were compared.ResultsThe recurrence rate was 2.71% (3 cases in 110 eyes) when an anchored conjunctival rotation flap technique was used and patients were monitored for 26.40 ± 17.09 months. Interestingly, the recurrences were only observed in polyglactin-sutured eyes. No recurrence was detected in nylon-sutured eyes. No other complications were observed in either group.ConclusionsThe anchored conjunctival rotation flap technique for pterygium surgery has a relatively low recurrence rate. Nylon suture-fixation of the flap was found to be superior to polyglactin suture-fixation in preventing recurrence.

A comparison of conjunctival rotation flap and autoconjunctival graft techniques in pterygium surgery at aldiwaniah teaching hospital from 2007_2013

purpose: to compare the result of conjunictival flap and autograft in term of recurrence rate and complication in Pterygium surgery.Methods: A total of sixty patients(twenty five male and thirty five female) operated for pterygium with conjunctival autografts(in 25 eyes) or conjuctival flap(in 35 eyes) technique at diwanyia teaching hospital and with 18 months follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface status .Result: Mean age was 42.5 years (range, 23–75), 58.33% of the patients were male, and 75% worked predominantly outdoors. Mean follow-up was 12 months (range, 3–18)Recurrence rate was 8%in graft,8.6%in flap, however edema was less in flap and granuloma was nil in both.Conclusions: After a long follow-up period for autograft and conjunctival flap pterygium surgery, there were no statistically significant differences in recurrence rates ,as well as flap is faster and easier technique with less postoperative edema.

A comparison of conjunctival rotation flap and autoconjunctival graft techniques in pterygium surgery at aldiwaniah teaching hospital from 2007_2013

purpose: to compare the result of conjunictival flap and autograft in term of recurrence rate and complication in Pterygium surgery.Methods: A total of sixty patients(twenty five male and thirty five female) operated for pterygium with conjunctival autografts(in 25 eyes) or conjuctival flap(in 35 eyes) technique at diwanyia teaching hospital and with 18 months follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface status.Result: Mean age was 42.5 years (range, 23–75), 58.33% of the patients were male, and 75% worked predominantly outdoors. Mean follow-up was 12 months (range, 3–18)Recurrence rate was 8%in graft,8.6%in flap, however edema was less in flap and granuloma was nil in both.Conclusions: After a long follow-up period for autograft and conjunctival flap pterygium surgery, there were no statistically significant differences in recurrence rates ,as well as flap is faster and easier technique with less postoperative edema.

A Comparison of Anchored Conjunctival Rotation Flap and Conjunctival Autograft Techniques in Pterygium Surgery

To compare conjunctival autograft and anchored conjunctival rotation flap techniques, in terms of recurrence and complication rates, after performing a primary pterygium surgery. Sixty patients who underwent pterygium surgery, which was performed on 1 eye (M:F = 25:35), either using conjunctival autograft (25 eyes) or anchored conjunctival rotation flap (35 eyes) techniques, were followed up postoperatively for a minimum period of 18 months. The anchored conjunctival rotation flap surgery was conducted by designing a conjunctival flap with a similar shape as that of the autograft, but with the preservation of the inferior limbal anchoring point (1 mm) by the incomplete cutting of the limbal area. After rotation of the flap around the anchoring point, the flap was tightened with sutures to cover the bare scleral area. Early postoperative complications, such as flap or graft edema and granuloma formation, were assessed. The recurrence rate of pterygium was evaluated, and a comparison was made between the 2 surgical techniques. The recurrence rate was 8.0% in the conjunctival autograft group and 8.6% in the anchored conjunctival rotational flap group (P = 0.659). However, the occurrence of flap or graft edema was lower for anchored conjunctival rotational flap surgery (14.3% vs. 72.0%, P < 0.001). No granuloma formation was observed in either group. The anchored conjunctival rotational flap surgery showed similar pterygium recurrence rates and a lower incidence of flap edema, while enabling simple recognition of flap orientation, compared with the conjunctival autograft technique.

Letter to the Editor Regarding "Conjunctival Rotation Autograft: An Alternative to Conventional Conjunctival Autografting".

Letter to the Editor Regarding "Conjunctival Rotation Autograft: An Alternative to Conventional Conjunctival Autografting".

Conjunctival Rotation Autograft for Pterygium: An Alternative to Conventional Conjunctival Autografting.

To determine the safety and efficacy of conjunctival rotation autograft (CRA) as an alternative to conventional conjunctival autograft after pterygium excision and its complications and rate of recurrence. A prospective non-comparative interventional case study. Conjunctival rotation autograft was performed under peribulbar block in 50 eyes with primary pterygium as well as recurrent pterygium of grade 1, 2 and 3 according to a morphological grading system. Patients were followed up for 12 months for complications like graft retraction, injection, recurrence, etc. A total of 55 CRAs were done in 50 eyes of 47 subjects in the study wherein grafts were attached by using the 10-0 nylon sutures in primary and recurrent pterygia. Mean follow up period was 11.67 months (Range 9-12 months). The most commonly found complications were graft injection in 16 (29.09%) cases and graft pigmentation in 5 (9.0%) cases. Injection was not associated with pterygium grade and was found to be statistically insignificant (P = 0.27). Recurrence was found only in 1 (1.8%) case in grade T3 recurrent pterygium. Conjunctival rotation autograft appears to be a successful and safe alternative to conjunctival autograft, with a relatively low rate of pterygium recurrence in this uncontrolled series. We advocate the use of CRA for cases of pterygium in which a conventional autograft is contraindicated or difficult. In addition, the procedure can be used as a primary surgical option in primary and recurrent pterygia.

Sarcome conjonctival de Kaposi

Kaposi sarcoma is rare and occurs in four forms (classic, endemic, post-transplant and epidemic), which all have the same histological appearance associated with the same viral agent: human herpes virus type 8 (HHV-8). Conjunctival and palpebral locations are, however, rare, and only 30 cases have been described in the literature. We present the case of a 34-year-old woman with conjunctival Kaposi angiosarcoma, with rare bulbar location associated with superior palpebral telangiectases against a rare immunodepression syndrome (common variable immunodeficiency). The treatment consisted of an excision biopsy with an over-and-over suture of a conjunctival rotation flap, combined with anti-HHV-8 chemotherapy to effect a regression of the palpebral lesion. However, the reappearance of a conjunctival lesion on the rim of the excision site required local radiotherapy of approximately 30 Gy, with no recurrence after 1 month.

Pterygium Surgery: Conjunctival Rotation Autograft Versus Conjunctival Autograft

To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.

Conjunctival Rotation Autograft for Primary Pterygium

Purpose: To evaluate the safety and effectiveness of conjunctival rotation autograft technique in preventing the recurrence of primary pterygium. Methods: In this prospective study, 24 eyes of 24 consecutive patients with primary pterygium were evaluated. Conjunctival rotation autograft technique, which involved the removal of the underlying fibrovascular pterygium tissue and replacement of the original epithelium over the bare sclera with a 180° rotation was performed in all eyes. Results: Patients were 34–70 years of age (mean, 52.8; SD = 10.5). During the mean follow-up of 15.9 months (range, 12–23 months; SD: 4.0), 4 recurrences (16.6%) were observed. Neither intraoperative nor postoperative complications were encountered except for recurrences and 3 suture openings, which were re-sutured postoperatively without further complications. Conclusion: Conjunctival rotation autograft technique appears to be effective and safe in preventing the recurrence of primary pterygium. A prospective randomised trial comparing conjunctival rotation autografting with other adjunctive procedures in addition to simple pterygium excision is required to determine its effectiveness.

Limbal-conjunctival autograft transplantation for recurrent pterygium.

To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium. Seventeen eyes with advanced recurrent pterygium underwent LCAT All had already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised. During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained. LCAT seems to be a promising and safe procedure for recurrent pterygium.

Bleb reduction and bleb repair after trabeculectomy

Objective To describe methods and outcomes for repair of bleb-related complications of trabeculectomy surgery. Design Retrospective, consecutive, noncomparative case series. Participants Thirty-one persons having bleb revision by two surgeons at the Wilmer Institute from 1994 to the present. Intervention One of two types of revision surgery was performed: bleb reduction to decrease symptoms from large blebs or bleb repair to improve hypotony, using conjunctival rotation flap or free conjunctival autograft. Main outcome measures Visual acuity, intraocular pressure (IOP), reported symptoms, complications, and number of glaucoma medications at the final visit. Results The mean time from trabeculectomy to bleb revision was 4.4 years. Bleb reduction was performed because of symptomatic, high blebs in 11 eyes of 11 persons. Bleb repair was performed to end bleb leakage in 13 eyes of 13 persons and to increase IOP in 8 eyes of 7 persons with hypotony. Median visual acuity improved from 20/50 before revision to 20/30 at most recent follow-up. Mean IOP increased after treatment from 7.7 ± 4.9 to 12.4 ± 4.0 mmHg ( P < 0.001). Symptoms that caused the revision surgery were eliminated in all cases. None of these eyes has lost IOP control, none has required repeat trabeculectomy, and only 2 of the 32 (6%) require topical glaucoma medication. More than one revision procedure was required in 8 of 32 (25%) eyes. Conclusions Surgical bleb revisions for complications after trabeculectomy surgery are safe and effective. Bleb reduction for large, symptomatic blebs or bleb repair for leaking blebs and hypotony did not lead to loss of IOP control.

Conjunctival grafting for ocular surface disease.

The procedure of transplanting healthy conjunctiva onto eyes with damaged ocular surface epithelium was first described by Thoft in 1977. Today, conjunctival autografting is widely used in pterygium surgery and has been shown to be both safe and effective in reducing pterygium recurrence. Several randomized, controlled, clinical trials have been reported in the literature, and conjunctival autografting is now recognized to have an efficacy equal to that of such adjunct therapies as beta-irradiation and mitomycin C, and yet it is safer than these treatments. Recent modifications of the conjunctival autograft include the conjunctival rotation autograft and the inferior conjunctival transposition flap, both of which have been reported to be associated with low rates of recurrence. With the discovery of the role of limbal stem cells in the maintenance and stability of the corneal surface, recent forms of ocular surface transplantation that have supplanted Thoft's conjunctival transplantation procedure include limbal autograft transplantation and limbal allograft transplantation. In addition, the adjunct use of human amniotic membrane in these ocular surface transplantation procedures has improved success and survival rates in the management of ocular surface disease, which still presents significant challenges to clinicians today.

Conjunctival rotation autograft for pterygium: An alternative to conjunctival autografting

Objective To determine the safety and efficacy of conjunctival rotation autografting (CRA) as an alternative to conventional conjunctival autograft after pterygium excision. Design Prospective noncomparative case series. Participants Consecutive patients seen at the Pterygium Clinic of the Singapore National Eye Centre who were thought to be unsuitable for conventional conjunctival autografting underwent a modified surgical procedure, which the authors describe as CRA. There were 51 rotation autografts performed on 45 eyes of 43 patients. Intervention In this procedure, the underlying fibrovascular pterygium tissue was removed and the original epithelium (with minimal subepithelial tissue included) replaced over the bare sclera with a 180° rotation. Surgeries were performed by one surgeon (DT) from April 1995 to May 1996. Main outcome measure Pterygium recurrence and complications of CRA were measured. Results The mean follow-up time was 12 months (range, 2–22 months). There were 46 primary and 5 recurrent pterygia. The indications for CRA were combined cataract and pterygium surgery (39.2%), double pterygia (31.4%), the need to preserve the superior conjunctiva (21.6%), and superior conjunctival scarring (7.8%). There were two recurrences (4% recurrence rate), one occurring at 4 months and the other occurring at 7 months after surgery. No significant complications were encountered. However, 50% of the grafts remained mildly injected for more than 3 months, and some remained injected for up to 13 months after surgery (average of 4 months). Pigmentary changes were also noted in six grafts (12%). Conclusion Conjunctival rotation autografting is a useful technique of conjunctival grafting in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.