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Mentions: In conjunctival autografting, the pterygium was extracted as described above, and the dimensions of bare sclera was measured. Superior temporal conjunctiva of the same eye, approximately 1 mm greater than bare sclera size, was measured and marked (Figure 1). The area under the marked space was inflated with lidocaine. The aim of this procedure was to ease the dissection of the conjunctiva from the tenon during autografting, and to obtain the thinnest possible conjunctiva. Afterwards, it was dissected as thinly as possible from the underlying adhesions. During the incising process we paid close attention to leaving the marked area within the autograft. In due course the autograft was freed by cutting the limbal edge of the conjunctiva (Figure 2). The autograft was flattened in place, and transferred to the receiver area by handling from the two limbal edges (Figure 3). The limbal side of the autograft was placed on the limbal area in the receiver area. As the autograft regularly flattened, it was sutured to the adjacent conjunctiva with continuous sutures and fixed to sclera at the limbus level (Figure 4). The autograft was sutured around the adjacent conjunctiva, and the eye closed with a rondell after application of antibiotic ointment application.
Comparing techniques for pterygium surgery
Bottom Line: In the conjunctival autografting group, 3 recurrences were observed.Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior.We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.
Affiliation: Department of Ophthalmology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
Abstract: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia;mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia;18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction;and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years.Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients.A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.
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