Conjunctival Limbal Autograft Research Articles

Simple limbal epithelial transplantation: Current status and future perspectives.

Damage to limbal stem cells as a result of injury or disease can lead to limbal stem cell deficiency (LSCD). This disease is characterized by decreased vision that is often painful and may progress to blindness. Clinical features include inflammation, neovascularization, and persistent cornea epithelial defects. Successful strategies for treatment involve transplantation of grafts harvested from the limbus of the alternate healthy eye, called conjunctival‐limbal autograft (CLAU) and transplantation of limbal cell sheets cultured from limbal biopsies, termed cultured limbal epithelial transplantation (CLET). In 2012, Sangwan and colleagues presented simple limbal epithelial transplantation (SLET), a novel transplantation technique that combines the benefits of CLAU and CLET and avoids the challenges associated with both. In SLET a small biopsy from the limbus of the healthy eye is divided and distributed over human amniotic membrane, which is placed on the affected cornea. Outgrowth occurs from each small explant and a complete corneal epithelium is typically formed within 2 weeks. Advantages of SLET include reduced risk of iatrogenic LSCD occurring in the healthy cornea at harvest; direct transfer circumventing the need for cell culture; and the opportunity to perform biopsy harvest and transplantation in one operation. Success so far using SLET is comparable with CLAU and CLET. Of note, 336 of 404 (83%) operations using SLET resulted in restoration of the corneal epithelium, whereas visual acuity improved in 258 of the 373 (69%) reported cases. This review summarizes the results of 31 studies published on SLET since 2012. Progress, advantages, challenges, and suggestions for future studies are presented.

Limbal stem cell transplantation and keratoprosthesis

AbstractLimbal stem deficiency (LSCD) is a severe ocular disease which may lead to vision impairment or corneal blindness. Beside conservative options like topical and systemical medical therapy, chronic stage treatment options include conjunctival replacement procedures and limbal autografting. If limbal cell transplanation in form of either cultivated limbal epithelial transplantation (CLET), simple limbal epithelial transplantation (SLET) or conjunctival limbal autograft (CLAU) and corneal transplantation are not successful a Keratoprosthesis in form of a Boston Keratoprosthesis or a Osteo‐odonto‐ Keratoprosthesis might be the last chance for these patients. In the following presentation indication and surgical options in LSCD will be discussed.

Effects of excimer laser phototherapeutic keratectomy in limbal-conjunctival autograft transplantation for recurrent pterygium: a retrospective case control study

BackgroundRepeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium. Our study is aimed to illustrate the effect of adjunct excimer laser phototherapeutic keratectomy (PTK) in limbal-conjunctival autograft transplantation on visual quality for patients with recurrent pterygium.MethodsRetrospective case-control study. Eyes that underwent pterygium excision with (PTK group) or without (control group) PTK from 2006 to 2017 were retrospectively included. Recurrence rate, preoperative and postoperative surface regularity index (SRI), surface asymmetry index (SAI), cylinder and LogMAR vision were collected. Postoperative anterior segment optical coherence topography and in vivo confocal microscopy were performed to monitor the cornea epithelium healing and cellular recovery process respectively.ResultsA total of 99 eyes of 99 patients were collected, of which 39 were treated with PTK and 60 without PTK. The mean follow-up time was 50.4 ± 38.1 months. The recurrence rate was 10.3% (4 eyes) in the PTK group and 13.3% (8 eyes) in the control group (p = 0.759). The SRI decreased 0.53 (range: − 0.88, 2.81), SAI decreased 0.53 (range: − 0.64, 2.94), and the cylinder decreased 2.08 (range:-0.16, 9.40) D in the PTK group, and the corresponding values were 0.48 (range:-0.45, 2.27), 0.27 (range:-1.06, 2.21) and 0.71 (range:-1.75, 3.55) D in the control group, respectively (Z = 1.76, 2.15, and 3.97, p = 0.005, 0.016, and 0.000 respectively). LogMAR vision improved in both groups after surgery, with an improvement of 0.18 (range: 0.00, 0.70) in the PTK group and 0.06 (range: − 0.12, 0.50) in the control group (Z = 4.08, p = 0.000). Besides, the eyes treated with PTK showed faster re-epithelization and better cellular recovery.ConclusionsFor recurrent pterygium, surgical excision with adjunct PTK might be a better option with improved corneal surface and vision outcomes.

Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery.

To compare the long-term outcomes of recurrent pterygium surgery between three different techniques. We performed a 15-year follow-up study of a randomized controlled study on surgical management of recurrent pterygium. Group 1 received limbal conjunctival autograft (LCAU); group 2 received intraoperative mitomycin C (MMC) 0.02% for 5 min; and group 3 received combined LCAU + MMC 0.02% for 5 min. Consecutive patients enrolled in the original study (from April 2001 to March 2003) were invited back for a detailed clinical examination to document the long-term outcomes. The main outcome measures included the recurrence rate, residual conjunctival bed status, and complications from any of the surgical methods. Sixty-two patients were recruited in the original study. Eight patients had passed away and 12 patients were uncontactable or not responded. One patient who had bilateral operations refused to return for follow-up and one eye had insufficient data for analysis. Finally, 40 eyes of 40 patients were included for analyses. One eye developed a recurrence over 15 years and none required a tertiary pterygium operation. The patient received LCAU for a temporal recurrent pterygium developed a 2.2-mm recurrence. All three techniques yielded favorable outcomes for patients with recurrent pterygium. The use of LCAU was associated with better cosmetic outcome.

Long-term outcomes of conjunctival limbal autograft in patients with unilateral total limbal stem cell deficiency

PurposeTo investigate the long-term clinical outcomes of conjunctival limbal autograft (CLAU) in patients with unilateral total limbal stem cell deficiency (LSCD). MethodsIn this retrospective interventional case series, the medical charts of patients with unilateral total LSCD were reviewed. Patients who underwent CLAU and no other allograft ocular stem cell transplantation with a minimum follow-up of 1 year were included. Main outcome measures were ocular surface stability, best-corrected visual acuity (BCVA), and postoperative complications. Results27 eyes fulfilled the inclusion criteria with a mean follow-up period of 49.8 ± 36.6 months (4.15 years; range 12–186.72 months; 1–15.56 years). Ocular surface stability was achieved in 77.8% (n = 21) of eyes at last follow-up, while 22.2% (n = 6) developed partial surface failure. Optical penetrating or deep lamellar anterior keratoplasty was performed in 44.45% (n = 12). BCVA improved from 1.42 ± 0.95 mean LogMAR (equivalent to 20/400) preoperatively to 0.53 ± 0.47 mean LogMAR (equivalent to 20/70) at last follow-up (p < 0.001). BCVA ≥20/40 was achieved in 44.45% (n = 12) at last follow-up. Microbial keratitis occurred in 14.81% (n = 4). Ocular hypertension secondary to corticosteroid use developed in 25.9% (7/27) eyes. There were no other complications in the donor or recipient eyes. ConclusionsCLAU can provide long-term ocular surface stability and successful visual outcomes in patients with unilateral LSCD.

Modified Sutureless and Glue-Free Method Versus Conventional Sutures for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Randomized Controlled Trial.

To compare the advantages and disadvantages of a modified sutureless and glue-free method with those of conventional sutures for conjunctival autograft fixation in pterygium surgery. A prospective randomized controlled study was performed on 73 eyes with primary nasal pterygium. After pterygium excision, the bare sclera was covered with a limbal conjunctival autograft, which was fixed using a modified sutureless and glue-free method in group 1 (39 eyes) and sutures in group 2 (34 eyes). The main outcome measures were operative time, autograft stability, postoperative discomfort, autograft thickness, pterygium recurrence, and complications. The mean operative time was significantly shorter in group 1 (11.9 ± 1.3 minutes) than in group 2 (24.3 ± 6.1 minutes, P < 0.0001). On day 2 postsurgery, the average conjunctival autograft thickness was significantly higher in group 1 (861 ± 340 μm) than in group 2 (577 ± 287 μm, P = 0.034). Subsequently, conjunctival autograft thickness gradually decreased, with no significant difference between groups after 1 week. There were no significant differences in postoperative discomfort between groups, except for a greater foreign body sensation on day 2 and an itching sensation in 1 week in group 2 compared with group 1. Autograft side displacement occurred in 4 patients (10.3%) in group 1; 2 of these 4 developed a granuloma. There was 1 recurrence (2.9%) in group 2. The modified sutureless and glue-free limbal conjunctival autograft fixation method might be effective and efficient for primary pterygium surgery, with potentially decreased recurrence and postoperative discomfort.

Pterygium surgery conjunctival limbal autograft versus amniotic membrane graft. A prospective and comparative study

Objective To know the outcome of pterygium surgery done by limbal- conjunctival autograft versus amniotic membrane graft using fibrin glue as a bio adhesive. This study was prospective and comparative study done at Regional Institute of Ophthalmology, IGIMS, Patna from July 2014 to June 2017. Materials and Methods: A prospective study was conducted on 96 patients with primary pterygium. Patients were divided into two groups. Group A and Group B on odd & even number basis respectively. Group A contains odd numbers of patient, in which limbal-conjunctival autograft was done and Group B pts with even numbers were subjected to amniotic membrane graft with fibrin glue. Patients were followed up on day 1, day 7, 1 month, 3 months and 6 months post–operatively. On each visit recurrence of pterygium, graft retraction, graft displacements, inflammatory reaction and comfort of pat was noted from both the group. Data was collected and analyzed with Microsoft Excel. Results: Recurrence of pterygium was seen in 3 patients (6.1%) out of 48 pts. in limbal-conjunctival autograft group A whereas in Group B, it was seen in 4 patients (8.10%) out of 48 patients in amniotic membrane graft with fibrin glue group. Keywords: Limbal- conjunctival autograft (LCAG), Amniotic membrane graft (AMG) with fibrin glue, Recurrence.

Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques

PurposeTo conduct a systematic review on outcomes of three different techniques of autologous limbal stem cell transplantation (LSCT): conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial...

OUTCOME OF AUTOLOGOUS LIMBAL CONJUNCTIVAL TRANSPLANTATION IN TERMS OF RECURRENCE RATE, AS THE MAIN OUTCOME MEASURE AND COMPLICATIONS AS THE SECONDARY OUTCOME

Purpose: To find the outcome of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome.&#x0D; Methods: The present study retrospective study conducted from a tertiary eye care hospital. Pterygium excision with limbal conjunctival autograft from the affected eye was performed for primary pterygium. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18 months for recurrence and other complications.&#x0D; Results: A total of 36 eyes of 36 patients with primary pterygia from November 2016 and October 2017 were included in the study. The study recruited 19 (52.7%) males and 17 (47.2%) females with mean age of 38.2 ±10.42 years. Pterygium was diagnosed more commonly in left eye(55.5%) as compare to right eye(44.4%). Out of 36 cases 32 (88.8%) cases of nasal and 4 (11.1%) cases of temporal pterygium noted. Out of 36 cases Graft edema in 1 (2.7%) case, graft retraction in 2 (5.5%) cases and 1 (2.7%) case of granuloma were noted. Any kind of pterygium recurrence and graft necrosis was not noted in present study.&#x0D; Conclusions: Pterygium excision with autologous limbal conjunctival autograft is safe and effective method to treat primary pterygium.

Comparison between Sutureless and Glue Free versus Sutured Limbal Conjunctival Autograft in Primary Pterygium Surgery

Introduction: To compare and evaluate the safety and efficacy of two surgical techniques for the management of primary pterygium.&#x0D; Materials &amp; Methods: The study included 176 eyes of 176 patients with primary pterygium. The mean age was 49 ± 12 years (range 24–74 years). Simple excision under local anesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 76 eyes of 76 patients (group 1), versus the conventional method of a sutured conjunctival autograft in 100 eyes of 100 patients (group 2).&#x0D; Results: The pterygium recurrence rate was 6% for group 1, 8% for group 2. Graft dehiscence occurred in 4 eyes out of 50 (8%) in group 1. Graft retraction occurred in 6 (12%) out of 50 eyes for group 1 versus 6 eyes (6%) in group 2. Pyogenic granuloma occurred in 3 (3%) eyes out of 100 in group 2. No other serious complications were noted. At the 3 week visit the overall patient satisfaction score was statistically significantly higher for group 1 (P &lt; 0.002) compared to group 2. At 3 months postoperatively, the gain in uncorrected visual acuity (UCVA) ranged from 0.2 to 0.5 Log MAR in 10 eyes.&#x0D; Conclusion: Sutureless and glue free conjunctival autograft technique is easy, safe, effective, prevents potential adverse reactions encountered with the use of foreign materials. This technique has an acceptable pterygium recurrence rate that is comparable to conventional sutured conjunctival autograft for primary pterygium.&#x0D; Medicine Today 2018 Vol.31(1): 1-8

Early postoperative outcomes of pterygium surgery: Sutures versus autogenous serum in-situ fixation of limbal conjunctival autograft

Limbal Conjunctival Autograft Transplantation (LCAT) is considered to be the most effective treatment option for pterygium with the least recurrence rate and rapid restoration of normal epithelial morphology. Of the many available methods for securing Limbal Conjunctival Autograft (LCAG), sutures and autogenous serum in-situ are cost-effective and offers better outcomes. AimTo compare the outcome of surgeries between the two groups: Group I - LCAG secured with autogenous serum in-situ versus Group II - LCAG secured with sutures. Main methodsA prospective randomized control trial conducted on 60 patients who were equally divided into two groups. Post-operative follow-up visits were scheduled at 1st week, 3rd week and 6th week. They were examined for pain, foreign body sensation, subconjunctival hemorrhage, tearing, hyperemia, graft edema, graft displacement, graft retraction, recurrence and/or any other complications and were graded depending on the severity. Mean surgical time was compared between the two groups. Key findingsAverage duration of surgery was significantly less in Group I than in Group II. Postoperatively, symptoms like pain, foreign body sensation, tearing and hyperemia were less common in Group I, furthermore subconjunctival hemorrhage and graft edema were more in Group II. SignificanceThough both the procedures are safe and effective, the use of autogenous serum in-situ significantly shortens the duration of surgery and is accompanied by lesser postoperative discomfort and inflammation. However, long-term studies are needed to assess the risk of recurrence. Graft displacement remains a severe, but infrequent complication.

Primary nasal pterygium excision with sutureless and glue-free technique of conjunctival autograft

Aim: To evaluate the efficacy and complication of sutureless and glue-free conjunctival autograft for the management of primary pterygium over a period of one year.&#x0D; Methods: Prospective, interventional, hospital-based study. Twenty-four eyes of 24 patients with primary nasal pterygium were graded, and excision was performed by a single surgeon. To prevent recurrence, a free conjunctival autograft was taken from the superior quadrant from the same eye and the bare sclera was covered without the use of sutures or fibrin glue, allowing natural autologous coagulum of the recipient bed to act as a bioadhesive. The eye was patched for 24 hours. Postoperatively, patients were put on topical eye drops (polymixin 0.5%, neomycin 0.5%, and dexamethasone 1%) four times daily for four weeks, and oral antibiotics and methyl prednisolone 3x4 mg per day for 5 days. Patients were followed up postoperatively on day 1, 1 week, 6 weeks, 6 months, and 12 months. They were examined for haemorrhage, wound gape, graft shrinkage, granuloma, graft dehiscence, recurrence, or any other complication.&#x0D; Results: The mean age of the patients was 56.96 ± 11.51 years (range 35-81 years). There were 18 females (75%) and 6 males (25%). The following complications were noted: granuloma in three eyes (12.5 %), overriding graft onto the cornea in three eyes (4.17%), and recurrence in one eye (4.17%). No other complications were noted. Average surgical time was 16 ± 2 minutes. &#x0D; Conclusion: Sutureless and glue-free limbal conjunctival autografting is a treatment modality for primary nasal pterygium with no additional cost and has only one recurrence case in 24 cases.

Long-term outcomes of donor eyes after conjunctival limbal autograft and allograft harvesting

ObjectiveTo investigate the ocular surface stability of donor eyes after conjunctival limbal autograft (CLAU) or conjunctival limbal allograft (CLAL). DesignRetrospective interventional case series. ParticipantsPatients diagnosed with limbal stem cell deficiency (LSCD) who underwent ocular surface stem cell transplantation with postoperative follow-up of at least 3 months. MethodsDonor eye data collected included preoperative and postoperative Snellen best-corrected visual acuity (BCVA), intraoperative and postoperative complications, re-epithelialization times, and ocular surface stability at the last follow-up. ResultsSixteen donor eyes of 16 patients were included, the mean age at the time of surgery was 59.3 years, and the mean follow-up period was 53 months. The most common injury etiology was chemical injury, followed by iatrogenic causes and Stevens-Johnson syndrome, then congenital aniridia. Eleven patients underwent CLAU, 3 underwent living-related CLAL, and 2 underwent CLAL combined with keratolimbal allograft. Preoperative mean donor eye BCVA was 0.22 ± 0.32 logMAR (Snellen equivalent ≈ 20/33), and mean BCVA at the last follow-up was 0.18 ± 0.24 logMAR (Snellen equivalent ≈ 20/30) (p = 0.4). All donor eyes had a stable ocular surface at the last follow-up, with no signs of iatrogenic LSCD or delayed corneal epithelial healing. There were no intraoperative or postoperative complications such as infections, persistent epithelial defects, corneal neovascularization, or chronic inflammation. ConclusionThis study provides additional evidence for the long-term safety of donor eyes when providing limbal stem cell tissue for CLAU or CLAL.

Study of refractive changes and recurrence of pterygium by pterygium excision with bare sclera technique and conjunctival limbal autografting

Study of refractive changes and recurrence of pterygium by pterygium excision with bare sclera technique and conjunctival limbal autografting

Limbal conjunctival autograft versus simple excision with intraoperative mitomycin C in pterygium surgery

Objective The aim of this study was to evaluate the recurrence and complications of limbal conjunctival autograft (LCAG) compared to simple excision with intraoperative mitomycin C (MMC). Background Pterygium recurrence is the most common postoperative complication. Many adjunctive methods have been used to reduce the recurrence such as chemical agents as MMC. In addition, the traditional bare sclera technique largely has been replaced by procedures that cover the sclera with conjunctival graft. Patients and methods This is a follow-up study of a randomized uncontrolled trial conducted on 100 eyes of 100 patients presented for pterygium excision. They were randomly allocated into two equally sized groups (50 patients in each): group 1 received intraoperative 0.02% MMC and group 2 received LCAG. After a follow-up time of 1 year, recurrences and complications were assessed. Results At 1 year of follow-up time, LCAG group had only one (2%) recurrence compared to eight (16%) recurrences in the MMC group that revealed a statistically significant difference (P = 0.031). Complications such as corneal epithelial defects, lacrimation, and photophobia were more commonly encountered in the MMC group but other complications such as graft retraction, dellen, fibrosis and symblepharon, conjunctival cyst, conjunctival hyperemia, irritation, and subconjunctival haemorrhage were similar in both groups. Conclusion Both LCAG and MMC are effective in the treatment of pterygium however, LCAG decreases recurrence rate and complications.

Analysis on the efficacy of different exsection range in pterygium

Objective To analyse the efficacy of different exsection range in pterygium excision combined with conjunctival limbal autograft transplantation. Methods The clinical data of 86 eyes of 86 patients with ptergium, from Jan. 2016 to Jan. 2017 were analyzed retrospectively.Among them 2 cases were recurrent pterygium. All cases were divided into 2 groups randomly.Group A, 44 cases, treated with pterygium extended excision combined with Tenon’s capsule excision.Group B, 42 cases, received obvious hyperplasia pterygium excision only.The follow-up time was 1 year.Postoperative recurrence rates, efficacy and complications between both groups were compared and analyzed. Results The difference of length, width of pterygium invaded the cornea and the age of onset were not statistically significant between the two groups (P=0.247, 0.185, 0.125). In group A, the conjunctival of grafting bed occurred persistent congestion in 3 eyes after surgery. At the end of follow up, no recurrent or scar exposure occured.In group B, there were 10 cases with repeated conjunctival congestion in grafting bed. The conjunctival fibrovascular tissue proliferation and significant scar tissue exposure occured in 5 eyes(11.9%). Conclusion Pterygium extended excision combined with Tenon’s capsule excision is an efficient method for pterygium.It may reduce recurrence and improve postoperative conjunctival congestion. Key words: Surgery; Pterygium; Exsection range; Recurrence

Optimal size of pterygium excision for limbal conjunctival autograft using fibrin glue in primary pterygia

BackgroundIn our study we describe a method that optimizes size of excision and autografting for primary pterygia along with the use of intraoperative MMC and fibrin glue. Our objective is to propose a simple, optimizedpterygium surgical technique with excellent aesthetic outcomes and low rates of recurrence and otheradverse events.MethodsRetrospective chart review of 78 consecutive patients with stage III primary pterygia who underwent an optimal excision technique by three experienced surgeons. The technique consisted of removal of the pterygium head, excision of the pterygium body and Tenon’s layer limited in proportion to the length of the head, application of intraoperative mitomycin C to the defect, harvest of superior bulbar limbal conjunctival graft, adherence of graft with fibrin glue. Outcomes included operative time, follow up period, pterygium recurrence, occurrences of incorrectly sized grafts, and other complications.ResultsAll patients were followed up for more than a year. Of the 78 patients, there were 2 cases of pterygium recurrence (2.6%). There was one case of wound dehiscence secondary to small-sized donor conjunctivaand one case of over-sized donor conjunctiva, neither of which required surgical correction. There were no toxic complications associated with the use of mitomycin C.ConclusionCorrelating the excision of the pterygium body and underlying Tenon’s layer to the length of the pterygium head, along with the use intraoperative mitomycin C, limbal conjunctival autografting, and fibrin adhesionresulted in excellent outcomes with a low rate of recurrence for primary pterygia.

Adjuvant Use of Cyclosporine A in the Treatment of Primary Pterygium: A Systematic Review and Meta-Analysis.

To evaluate the efficacy and tolerability of cyclosporine A (CsA) as an adjuvant treatment for primary pterygium. A comprehensive literature search from 7 databases (EMBASE, ISI Web of Science, PubMed, and the Cochrane Library for studies published in English and VIP, Wan Fang, and CNKI for studies published in Chinese). For the recurrence rate, pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Tolerability estimates were measured by OR for adverse events. A total of 7 studies meeting the inclusion criteria were included in this meta-analysis. Compared with the group with adjunctive CsA usage, the control group (no adjuvant use of CsA) showed a significantly increased risk of pterygium recurrence (OR = 2.71; 95% CI, 1.62-4.54). No obvious heterogeneity was detected in the included studies. Subgroup analysis showed that adjuvant use of CsA with pterygium excision alone resulted in a significantly lower frequency of recurrence than was seen in the group without adjuvant use of CsA (OR = 3.16; 95% CI, 1.18-8.84). However, there is no significant difference in pterygium recurrence between the subgroup (CsA + pterygium excision + limbal conjunctival autograft or flap rotation) and the subgroup without adjunctive CsA usage (pterygium excision + limbal conjunctival autograft or flap rotation). This meta-analysis suggests that adjuvant use of CsA can significantly reduce the risk of pterygium recurrence compared with pterygium excision alone, whereas adjuvant use of CsA may not reduce the risk of pterygium recurrence in terms of pterygium excision + limbal conjunctival autograft or conjunctival flap rotation.

Surgical management of severe ocular surface injury due to Roman candle explosion accidents

PurposeTo report the clinical features, management, and outcomes of patients with ocular surface damage secondary to Roman candle explosion accidents. MethodsRetrospective, noncomparative, interventional case series of 11 patients with Roman candle explosion-related ocular surface injuries referred to the Cincinnati Eye Institute between 2007 and 2016. ResultsEleven patients (10 male, 1 female, mean age 22.4 years) sustained unilateral ocular surface injuries with presenting visual acuity ranging from count fingers to light perception. All patients had severe limbal stem cell deficiency with total ocular surface failure. Eight eyes received a conjunctival-limbal autograft (CLAU) with a keratolimbal allograft (KLAL), 1 eye received a living related-conjunctival limbal allograft (lr-CLAL) with a KLAL, and 2 eyes received a CLAU with lr-CLAL. Nine eyes underwent subsequent penetrating keratoplasty, and 7 eyes had reconstructive eyelid surgery. Nine eyes demonstrated improved visual acuity at last follow-up; seven eyes demonstrated a stable ocular surface at last follow-up. Nonadherence was noted in 7 patients, either with poor adherence with post-operative treatment or poor follow-up; this portended a worse visual result. ConclusionsRoman candle-related accidents can lead to severe ocular surface injury. Despite total ocular surface failure, these eyes can achieve good postoperative visual results following limbal stem cell transplantation and subsequent keratoplasty with appropriate compliance.

Risk factors for pterygium recurrence after limbal-conjunctival autografting: a retrospective, single-centre investigation.

To determine the risk factors related to recurrence of pterygium after pterygium excision with limbal-conjunctival autograft. Retrospective, observational case series. The current study included 310 patients who underwent surgical removal of pterygium using limbal-conjunctival autografting. All surgery was performed by the same surgeon at a single Hospital from 2006 to 2011. Preoperative and postoperative patient data were collected. The patients were summoned to follow-up examinations. Procedures with at least 12months of follow-up were included in the final analysis. Potential risk factors for pterygium recurrence were determined by Cox proportional-hazard linear analysis and recurrence-free survival time was evaluated using Kaplan-Meier method. The overall recurrence rate was 5.2% during an average follow-up time of 20.1±8.6months (range, 12-37months). According to Kaplan-Meier evaluation, the estimated time to recurrence was 34.2 ± 0.5months (95% confidence interval 33.3-35.0months) for the whole population. Multivariate analysis showed that age < 45years old (RR = 3.582, 95% CI 1.984-13.044, P = 0.047), recurrent type of pterygia (RR = 4.856, 95% CI 1.794-13.142, P = 0.002), and vertical size of pterygium > 6.7mm (RR = 2.529, 95% CI 1.053-6.075, P = 0.038) were significantly associated with increased risk of recurrence. Our findings suggest that young age, recurrent type of pterygia, and larger pterygial tissue are risk factors for pterygium recurrence after surgical excision. Hence, early excision of pterygium is recommended to decrease the recurrence rate.