Conjunctivolimbal Autograft Research Articles

Long-term ocular surface stability in conjunctivolimbal autograft and ocular surface safety in the donor eyes.

The current study is aimed to present the long-term results of the patients who underwent conjunctivolimbal autograft (CLAU) as the primary operation in unilateral limbal stem cell deficiency and the ocular surface safety of the donor eyes. The patients were followed up for fiveyears or longer. The records of all patients who underwent CLAU as the primary operation were retrospectively analyzed. Additional ocular surface operations, ocular surface stability, best-corrected visual acuity (BCVA), and ocular surface status of the donor eyes were investigated. The mean age of the patients at the time of transplantation was 35.07 ± 12.9 (12-60). Twenty-nine eyes of 29 patients were followed up for an average of 97.82 ± 34.45 (60-186) months. Additional ocular surface operation was required in 27.58% (8/29) of the eyes in order to achieve a stable ocular surface. Ocular surface stability was achieved in 82.75% (24/29) of the eyes at the end of the follow-up period. BCVA increased from 1.78 ± 0.82 to 0.91 ± 0.92 logMAR at the last visit (p < 0.001). Corneal ectasia and vascularization developed in one donor eye in the fifth postoperative year. CLAU tissues provide ocular surface stability with a successful vision result in the long term. CLAU theoretically carries risks including limbal stem cell deficiency in the donor eye. In the long-term follow-up of donor eyes after CLAU, ectasia and limbal stem cell deficiency were observed in one eye.

Effects of Subconjunctival Bevacizumab Injection after Primary Pterygium Surgery

Purpose: This study evaluated the efficacy and safety of subconjunctival bevacizumab injection after primary pterygium surgery.Methods: We performed a conjunctivo-limbal autograft after pterygium resection in 136 eyes of 128 patients with primary pterygium between December 2019 and July 2021. A subconjunctival bevacizumab injection of 2.5 mg (0.1 mL) was administered in the bevacizumab group but not in the control group (54 eyes of 48 patients). We compared pterygium recurrence rates between the two groups at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery.Results: Pterygium recurrence occurred in one eye (1.21%) in the bevacizumab group and five eyes (9.25%) in the control group. Additionally, fibrovascular tissue proliferation was suppressed in the bevacizumab group and no postoperative complications were observed.Conclusions: Pterygium recurrence occurred in one eye (1.21%) in the bevacizumab group and five eyes (9.25%) in the control group. Additionally, fibrovascular tissue proliferation was suppressed in the bevacizumab group and no postoperative complications were observed.

A comparative study on the use of fibrin glue versus sutures in pterygium surgery with conjunctivolimbal autograft and its impact on higher-order aberrations

A comparative study on the use of fibrin glue versus sutures in pterygium surgery with conjunctivolimbal autograft and its impact on higher-order aberrations

Changes in Eye Movement Amplitude after Conjunctivo-Limbal Autograft in Patients with Recurrent Pterygium, Ocular Motility Restriction

Changes in Eye Movement Amplitude after Conjunctivo-Limbal Autograft in Patients with Recurrent Pterygium, Ocular Motility Restriction

Sutureless Versus Suture Technique for Conjunctivolimbal Autografting in Primary Pterygium Excision: A Prospective Study.

PURPOSE:Conjunctivolimbal autograft is proposed to be the best treatment for pterygium and autograft can be fixed either with sutures or without. This study was undertaken to assess and compare the efficacy of sutureless versus suture techniques for conjunctivolimbal autografting in primary pterygium.METHODS:A prospective observational study was conducted in the department of ophthalmology in a tertiary care center from March 2018 to September 2019. Twenty consecutive patients in the age group of 20 to 70 years with primary pterygium were included. Ten patients underwent suture technique for autograft placement, whereas ten patients underwent sutureless technique. Comparison of both the groups was done in terms of duration of surgery and postoperative symptoms. Data were entered into Microsoft Excel software and analyzed using SPSS software.RESULTS:In the first group, the mean duration of surgery was 48 min and it was 38 min in the second group. The difference was statistically significant (P = 0.000). Postoperatively, foreign-body sensation was present in nine patients in the first group, whereas it was absent among the patients in the second group. The difference was statistically significant (P = 0.000). Four patients in the first group and two patients in the second group had postoperative hyperemia and only one patient in the first group had conjunctival chemosis. A graft-related complication was present in one patient in the second group.CONCLUSION:Sutureless technique is a better technique as compared to conventional suture technique.

Analysis of Donor-site Complications after Conjunctivo-limbal Autograft to Treat Pterygium

Analysis of Donor-site Complications after Conjunctivo-limbal Autograft to Treat Pterygium

Primer ve Reküren Pterijiumlu Hastalarda Konjonktivolimbal Otogreft Tekniği Sonuçlarımız

Amaç: Bu çalışmada primer ve reküren pterijiumda konjonktivolimbal otogreft cerrahisinin sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ocak 2012—Aralık 2016 döneminde Afyon Kocatepe Üniversitesi Hastanesi Göz Kliniği’nde primer ve reküren pterijium nedeniyle konjonktivolimbal otogreft cerrahisi yapılan hastalar retrospektif olarak değerlendirildi. Bulgular: Çalışmaya toplam 130 hasta dahil edildi; 18 hastanın 19 gözünde reküren pterijium, 112 hastanın 131 gözünde primer pterijium vardı. Ameliyat edilen hastaların 66’sı kadın, 64’ü erkekti. Hastaların yaş ortalaması 62,60±1,16 (25–89) yıl idi. Ameliyat sonrası takiplerde 5 (%3,3) gözde sütüre bağlı enflamasyon, 1 (%0,66) gözde dellen, 6 (%3,9) gözde nüks saptandı. Bunlar dışında hiçbir komplikasyona rastlanmadı. Tartışma ve Sonuç: Primer ve reküren pterijium tedavisinde, konjonktivolimbal otogreft transplantasyonu düşük nüks oranlarına sahip, etkili ve güvenilir bir yöntemdir

Long-term Outcomes of Conjunctivo-limbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

Long-term Outcomes of Conjunctivo-limbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

Is the surgical technique of a sutureless and glue-free conjunctivolimbal auto graft after pterygium excision complications free?

Context: Sutures or fibrin glue have been used to fix a conjunctival graft after pterygium excision. A new surgical technique of using patient's own blood to affix the conjunctival graft after excision of pterygium has been introduced. This technique is safe, economical and reduces complications related to the use of foreign materials. Aim: The aim was to evaluate the surgical technique of a sutureless and glue-free graft for pterygium surgery in terms of complications such as loss of graft, graft dehiscence, and recurrence. Materials and Methods: This was a prospective interventional study. All patients that came to the outpatients department from July 2012 to December 2012 were included in the study. Pterygium excision with conjunctivolimbal autografting without using suture or glue was carried out in all patients. Patients were followed-up postoperatively up to 6 months. They were examined mainly for postoperative complications. Results: A total of 79 eyes of 74 patients underwent suture less glue-free autologous conjunctivolimbal graft after pterygium excision. There were 53 female (mean age-46.85 years standard deviation (SD) 10.59) and 26 male (mean age-45.04 years SD 17.27) patients. There were 77 cases of primary pterygium and two cases of recurrent pterygium. Medial edge recession of the graft was seen in one case (1.2%), whereas two cases (2.5%) had lost graft on the first postoperative day. There were no recurrences at the end of 6 months. Conclusion: The surgical technique of using a sutureless and glue-free conjunctivolimbal autograft is safe and cost-effective. However, this technique is associated with few complications such as medial edge recession and loss of graft.

Ocular surface reconstruction by cultivated epithelial sheet transplantation.

Recent advances in ocular surface reconstruction for patients with severe ocular surface diseases have significantly improved the prognosis of patients with vision-impairing corneal abnormalities. The history of cultivated epithelial sheet transplantation is short, and debate on the current approaches for these procedures is continuing. Limbal stem cell transplantation, including conjunctivolimbal autograft and keratolimbal allograft, has brought opportunities for vision improvement. In addition, the use of cultivated limbal epithelial transplantation from both allogeneic and autologous sources has provided further options for immediate postoperative epithelialization of the corneal surface. Finally, cultivated oral mucosal epithelial transplantation, which allows autologous transplantation for patients with bilateral limbal stem cell deficiency, has provided the best overall midterm and long-term results. Its biggest advantages are the absence of rejection reactions and the reduction of postoperative complications associated with steroid therapy. However, a solitary surgical approach is not sufficient for obtaining a good clinical outcome. To maximize the possibility of success using these procedures, it is important to preoperatively enhance aggressive treatment of the ocular surface, especially with factors that facilitate moisture retention. In this review article, we also discuss our clinical experience in relation to these surgical procedures.

English

AIM: Evaluation of the benefits of suture less and glue free conjunctivo-limbal autograft for primary pterygium management. MATERIALS AND METHODS: This was clinical outcome study of 50 consecutive eyes with primary nasal pterygium requiring surgical excision. Autologous conjunctival graft taken at the superotemporal limbus was used to cover the sclera after pterygium excision. Sutureless and glue free conjunctivo-limbal autograft was performed in all the patients followed by bandaging for 24 hours. The patients were followed up post operatively on 2nd day, 1 week, 4weeks, 3 months, 6 months and 12 months. They were examined for subconjunctival hemorrhage, granuloma formation, graft dehiscence, graft rejection, graft retraction, chemosis, recurrence or any other complication. RESULTS: The study included 28 females and 17 males (mean age 39.3 years). Recurrence was seen in one eye (2.2%) of a patient at one year. Graft retraction on conjunctival side occurred in 5 eyes (11.1%). Partial Inferior flaps dehiscence in 2 patients (4.4%) and one conjunctival granuloma (2.2%) were noticed during 1 st week follow up. No any major postoperative complications occurred. CONCLUSION: The described technique is fast, safe, and effective and as well as economical while giving results without any increased chances of complications for the management of primary pterygium.

Is amniotic membrane transplantation, an adjuvant of choice following excision of primary Pterygium?

Though, Conjunctivo-limbal auto-graft is the most accepted adjuvant to prevent recurrence of pterygium, has its own limitations like difficulty to cover large defect and to preserve for future glaucoma surgeries, necessiating to find an alternative especially, in young patients. The outcomes between amniotic membrane transplantation (AMT) and conjunctivo-limbal auto graft transplantation (CLAT) as an adjuvant following excision of primary pterygia from Jan. 2010 to Dec.2010 were compared. Twenty four patients had AMT and 28 patients had CLAT after pterygium excision and followed for minimum of 12 months; evaluated in terms of recurrence or complications. We had 44% young (<40yrs) with 58% female. Epithelial healing occurred within a week. AMT cases showed 8% recurrence, nil in CLAT but, with 2 cases of pyogenic granuloma. We conclude that, AMT as an adjuvant would be a viable option reserving CLAT for those with recurrence or as a last resort especially, in younger patients.

Mooren Ulcer Occurring at Donor Site After Contralateral Conjunctivolimbal Autograft for Recurrent Pterygium

Mooren Ulcer Occurring at Donor Site After Contralateral Conjunctivolimbal Autograft for Recurrent Pterygium

Intraoperative Subconjunctival Bevacizumab as an Adjunctive Treatment in Primary Pterygium: A Preliminary Report

To evaluate the safety and efficacy of intraoperative subconjunctival bevacizumab as an adjunctive treatment after surgical excision of primary pterygium. This was a randomized prospective clinical study. Group 1 (21 eyes) underwent pterygium excision with conjunctivo-limbal autograft. Group 2 (20 eyes) received subconjunctival 1.25 mg/0.05 mL of bevacizumab at the end of the surgery. There were no statistically significant differences regarding age, sex, laterality, or dimensions of the pterygia or grafts between the two groups (P > .05, 95% confidence interval). After 8 months of follow-up, two eyes in group 1 and four eyes in group 2 had recurrent pterygia. One patient in group 2 had lost graft. The difference in recurrence rate between the two groups did not reach statistical significance (P = 0.4, 95% confidence interval). Intraoperative subconjunctival bevacizumab following primary pterygium surgical excision is not helpful and possibly harmful. Larger studies are needed.

Ocular Surface Reconstruction After Exposure to High Concentrations of Antiseptic Solutions

To report the clinical course in accidental exposure of the cornea to antiseptic solutions in 3 cases. Observational case series. Exposure to 20% chlorhexidine gluconate solution was observed in 2 cases and to 10% benzalkonium chloride solution in 1 case. Not only superficial damage but also toxicity to corneal endothelial cells leading to corneal edema was observed in all 3 cases. Epithelial transplantation was performed: autologous cultivated limbal epithelial transplantation (auto-CLET), conjunctivolimbal autograft (CLAU), or living-related cultivated limbal epithelial transplantation (lr-CLET). A stable ocular surface was achieved, although exposure to high concentrations of antiseptic solutions caused severe anterior chamber inflammation; cataract and glaucoma developed in 2 cases, requiring further surgical treatment. Exposure to high concentrations of antiseptics causes both ocular surface and intraocular damage. Epithelial transplantation enables restoration of a stable ocular surface. However, management of intraocular consequences, including secondary glaucoma and corneal endothelial damage, still remains a challenge in the prognosis of such cases.

Limbal stem cell transplantation techniques

AbstractLimbal epithelial stem cells (LSC) are essential for the regeneration of the corneal epithelium. Limbal stem cell deficiency (LSCD) that can develop in traumatic, immunologic, or genetic diseases affecting the ocular surface is a major cause of corneal transparency loss.Limbal stem cell transplantation (LSCT) aims to restore a corneal epithelial phenotype, essential to maintaining the corneal transparency. The source of donor tissue containing LSC for in vivo expansion, can be the healthy fellow eye (Conjunctivo Limbal Autograft (CLAU)), living‐related (LR) Conjunctivo Limbal Allograft or cadaveric (Kerato Limbal Allograft (KLAL)). Sheets of ex vivo expanded bioengineered epithelial cells (from autologous origin (LSC / oral mucosa) or LR (LSC) are an alternative. Before and after transplantation a proper control of the ocular surface inflammation is essential. Systemic and topical immunosuppressive treatment is also needed in all allograft recipients. In order for the surgical restoration of the corneal transparency to be complete, lamellar and penetrating keratoplasty are often required.

Novel sutureless transplantation for primary pterygium associated with cysts.

To evaluate the efficacy and safety of a novel sutureless AMT (amniotic membrane transplantation) or CAT (conjunctivolimbal autograft transplantation) using fibrin glue for reconstructing corneoconjunctival surfaces for primary pterygium associated with cysts. A prospective descriptive study was made of the period 1 January 2006-1 May 2009. Nine patients with primary pterygium associated with cysts underwent pterygium and cyst excision followed by sutureless AMT or CAT using fibrin glue. During a mean follow-up of 8.00±0.67 months, all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium. All eyes have good tear secretion function, tear film stability and ocular motility. Sutureless transplantation using fibrin glue is safe and effective for restoring a stable corneoconjunctival epithelium in primary pterygium associated with cysts.

Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

Purpose: To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium. Methods: Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively. Results: With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups. Conclusions: Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

PurposeTo evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium.MethodsThirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations.ResultsThe mean patient age was 57.9±10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05±5.78 weeks. The mean surgery time was 18.04±5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive.ConclusionsThe use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms. Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

Purpose: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia. Methods: Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated. Results: With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group. Conclusions: Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.