Conjunctival Transposition Flap Research Articles

Pterygium surgery by double-sliding flaps procedure

Purpose:This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two conjunctival flaps.Methods:This retrospective study divided 193 cases of pterygium into the primary (140 cases) and recurrent (53 cases) pterygium groups. Following double-sliding conjunctival transposition flap operation and surgical excision of the pterygium, the success and recurrence rates of pterygial surgery were assessed based on visual acuity and corneal and total astigmatism during follow-up at least 6 months.Results:Both primary and recurrent pterygium groups showed significant improvements in visual acuity and astigmatism (corneal and total) between before and after this procedure. Total astigmatism and success rate of primary pterygium were significantly better than those for recurrent pterygium. Two cases (1.4%) of primary pterygium and four cases (7.5%) of recurrent pterygium developed recurrence, corresponding to a rate of 3.1% (6/193 cases). The success rates significantly make a difference between primary and recurrent groups but did not differ significantly between the first recurrent and over twice recurrent pterygium. However, visual acuity, cornea, and total astigmatism improved significantly after surgery in first recurrent group but not in over twice recurrent group.Conclusion:The double-sliding conjunctival flaps surgery appeared to be a useful method, with a better success rate and lower pterygial recurrence in pterygium surgery. Especially, when pterygium is larger or recurrent type, this technique can be easily covered the bare sclera, as compared to any transposition conjunctival flap operation.

Long - Term Results of Primary Pterygium Surgery with Conjunctival Transposition Flap

Long - Term Results of Primary Pterygium Surgery with Conjunctival Transposition Flap

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

PurposeTo investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery. DesignRetrospective, interventional case series analysis. Materials and methodsMedical records of 48 patients who underwent pterygium surgery by conjunctival autograft or conjunctival transpositional graft for primary pterygium surgery were reviewed. The conjunctival defects after pterygium excision were repaired in 21 eyes with conjunctival autograft and in 27 eyes with conjunctival transpositional flaps. All operations were performed under subconjunctival anesthesia using 8.0 vicryl sutures. Two groups were compared in terms of pterygium size, surgery time, complications and pterygium recurrence. ResultsMean pterygium size was 2.8 mm in conjunctival transpositional flap group, and 3.4 mm in conjunctival autograft group (p < 0.01). Mean surgery time in conjunctival transpositional flap and conjunctival autograft groups was 15.9 and 21.7 min, respectively. The haematoma formation under the graft was observed postoperatively in one eye of conjunctival autograft group. The only one case of recurrence was observed in both conjunctival autograft and conjunctival transpositional flap groups (3.7% and 4.7%, respectively). Mean follow up time was 11.78 months in conjunctival transpositional flap group and 14.95 months in conjunctival autografting group (p < 0.01). ConclusionBoth conjunctival transpositional flap and conjunctival autograft techniques have same results in terms of pterygium recurrence and surgery complications in the treatment of primary pterygium. Surgery time in conjunctival transpositional flap technique is significantly shorter. Conjunctival transpositional flap technique may be a good alternative method for primary pterygıum surgery.

The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium

The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium

Comparison of clinical efficacy of three surgical methods in the treatment of pterygium.

To investigate and compare the efficacy of amniotic membrane transplantation, corneal limbus stem cell conjunctival transplantation and pedicle conjunctival flap transposition in the treatment of pterygium. A total of 155 patients with pterygium were retrospectively analysed: 53 cases who received amniotic membrane transplantation, 41 who underwent corneal limbus stem cells conjunctival transplantation, and 63 patients who had pedicle conjunctival flap transposition. Patients in the three groups had no significant differences in terms of age, times since surgery, or extent of pterygium extension onto the cornea (F:1.194, 0.639, 0.140 respectively; all P>0.05). A total of 137 out of 155 patients (88.4%) completed 6 months of follow up. The recurrence rates of pterygium for the three surgeries (amniotic membrane transplantation, corneal limbus stem cells conjunctival transplantation and pedicle conjunctival flap transposition) were 14.6%, 13.9% and 7.7%, respectively. No significant difference was identified when comparing the recurrence rate between any two groups (X2: 0.008, 1.211 and 0.890; P: 0.593, 0.218 and 0.276). Five patients presented with postoperative complications, including 3 cases of sub-conjunctival hemorrhage, 1 case of amniotic membrane dissolution, and 1 case of conjunctival cyst, accounting for 3.64% of all participants. These three surgical methods are equally effective in preventing the recurrence of pterygium after excision.

Improved conjunctival transplantation for corneal ulcer.

To evaluate the therapeutic effect of pedical conjunctival flap transposition on refractory corneal ulcer. The data of 56 eyes of 56 patients with refractory corneal ulcer who underwent pedical conjuctival transposition in a tertiary eye unit in China from June 2005 to June 2009 were retrospectively analyzed. There were 36 infective corneal ulcers, 9 keratoplasty graft ulcers, 4 traumatic ulcers, and 7 chemical burn ulcers. All patients were treated with focal debridement and pedical conjuctival flap transposition. Forty-seven out of 56 (83.9%) were cured after one surgery, and 5 (8.9%) had conjunctival flap retraction, among which 3 underwent the second surgery and 2 had the third surgery to completely heal. Four patients (7.2%) turned to lamellar keratoplasty because of fungal corneal ulcer relapse. Ulcer in 52 patients healed and the globe preserved. They had different levels of vision improvement. Pedical conjunctival flap transposition is effective for refractory corneal ulcer.

Effect of Inferior Conjunctival Transposition Flap Surgery for Primary Pterygium

Purpose: To evaluate the efficacy and safety of the inferior conjunctival transposition flap for primary pterygium surgery. Methods: This study reviewed 59 eyes in 59 patients with primary pterygium who were treated with pterygium excision and an inferior conjunctival transposition flap. The inferior conjunctival flap was obtained from lower bulbar conjunctiva and was secured with 8-0 vicryl. Patients were followed-up on the third day after surgery and then at 1, 2, 4 and 12 weeks postoperatively. Results: The mean patient age was 55.6 (ranging from 34 to 74) years. The mean follow-up period was 24.9 (ranging from 12 to 46) months. During the follow-up period, the pterygium recurred in one (1.7%) of the 59 eyes. There were no severe complications except for mild congestion and hemorrhage of the conjunctival flap. Conclusions: Inferior conjunctival transposition flap technique may be considered as a safe and effective method that reduces complications and recurrences after primary pterygium excision.

A Case of Conjunctival Autotransplantation Using Conjunctival Flap of Pterygium in Treating Corneal Ulcer Perforation

Purpose: To report a case of conjunctival autotransplantation using the conjunctival flap of the pterygium for thetreatment corneal ulcer perforation. Case summary: A 72-year-old woman was referred to our hospital because her left eye had a corneal ulcer due topine needle trauma, and she did not respond to the initial therapy in a private clinic for 1 week. We first applied topical and systemic antibiotics. However, the lesion did not subside, and necrosis progressed in the stroma at the center of the cornea. On day 6 of admission, perforation was found at the center of the cornea, and we excised the necrotic tissue and performed bilateral pedicle conjunctival flap transposition. After the operation, an ischemic change was observed, and in the fourth week perforation occured at the center of the transplanted conjunctival flap. Because we considered it difficult to perform the transplantation of a conjunctival flap in the left eye, we performed autotransplantation on the corneal perforation in the left eye using conjunctival flap obtained through a pterygium excision in the right eye. After the operation, vascular ingrowth started from the edge of the flap, and there were no symptoms of inflammation, shrinkage, or necrosis of the flap. During the follow-up observation, the flap survived well without necrosis.

Combined ‘symmetrical conjunctival flap transposition’ and intraoperative low‐dose mitomycin C in the treatment of primary pterygium

To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.

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.

Primary Pterygium Surgery Using the Inferior Conjunctival Transposition Flap

The authors investigated a surgical method for primary pterygium without adjunctive therapy and devised a technique called the inferior conjunctival transposition flap. The procedure was performed by making a flap of the inferior conjunctiva after excision of the pterygium, and transpositioning it to make a covering for the bare sclera and donor site and a barrier to pterygium tissue. This method has been used on 54 eyes of 50 patients (mean age 47 years, range 18 to 69 years) with primary pterygium. All of these patients were treated by one surgeon. During a follow-up period of 12 to 26 months (mean 20 months), the pterygium recurred in 3 (5.6%) of the 54 eyes. In all other cases good anatomic and cosmetic results were achieved without any serious complications. The authors concluded that the inferior conjunctival transposition flap is an encouraging technique for the treatment of primary pterygium.