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P.D. Gandhi, R.E. Stevens; A Surgical Approach to Pterygium Excision and Conjunctival Autograft that Prevents Recurrence and Graft Failure . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1321.
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Purpose: To assess the success rate of pterygium excision with conjunctival autograft using an approach to minimize inflammation and reduce pterygium recurrence. Methods: This is a longitudinal consecutive case series of primary and recurrent pterygia in an endemic area over 11 years. One hundred-fifty consecutive male and female patients, ages 14 to 83, from a multiethnic population were included. All patients had pterygia, 3/4 primary and 1/4 recurrent. Most were nasal, few bilateral, and all selected surgical cases were symptomatic despite medical therapy. A uniform surgical technique was applied: Complete excision of the pterygium by exposing the underlying rectus muscle to remove all pterygium tissue before severing the base. The pterygium head in all cases was removed from the cornea by means of blunt dissection. The resulting large bulbar conjunctival defect was then covered with an identically sized free autograft taken from superior bulbar conjunctiva, sutured limbally and radially to episclera and recipient conjunctiva using 10-O nylon with buried knots to reduce post-operative inflammation. The posterior graft was fixed to episclera or superficial rectus muscle with interrupted 7-O vicryl sutures without closing to recipient conjunctiva. No patients received radiation or anti-metabolite therapy. All patients were followed post-operatively for a minimum of 6 months. Results: The most common post-operative complications were transient, including intra-ocular pressure rise, diplopia in extreme gaze, and pyogenic granuloma at the donor site. There are no documented cases to date of graft failure or pterygium recurrence in this series. Conclusions: Pterygium recurrence and conjunctival graft complications can be prevented without adjunctive therapy by utilizing our surgical approach. To our knowledge, this is the largest long-term series to date in the literature achieving this rate of success.
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