September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
First Report of Simultaneous Double-Headed Pterygiectomy with Conjunctival Autograft, Amniotic Membrane and Fibrin Glue
Author Affiliations & Notes
  • Jenny Ha
    Visionary Ophthalmology, Rockville, Maryland, United States
  • Jesus Alberto Martinez
    Visionary Ophthalmology, Rockville, Maryland, United States
    Ophthalmology, Medstar Georgetown University Hospital / Washington Hospital Center, Washington, District of Columbia, United States
  • Yasaman Hosseini
    Visionary Ophthalmology, Rockville, Maryland, United States
  • Michael Korchak
    Ophthalmology, Medstar Georgetown University Hospital / Washington Hospital Center, Washington, District of Columbia, United States
  • Jayson Koppinger
    Georgetown University School of Medicine, Washington, Maryland, United States
    Ophthalmology, Medstar Georgetown University Hospital / Washington Hospital Center, Washington, District of Columbia, United States
  • Sandra Lora Cremers
    Visionary Ophthalmology, Rockville, Maryland, United States
  • Footnotes
    Commercial Relationships   Jenny Ha, None; Jesus Martinez, None; Yasaman Hosseini, None; Michael Korchak, None; Jayson Koppinger, None; Sandra Cremers, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3875. doi:
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      Jenny Ha, Jesus Alberto Martinez, Yasaman Hosseini, Michael Korchak, Jayson Koppinger, Sandra Lora Cremers; First Report of Simultaneous Double-Headed Pterygiectomy with Conjunctival Autograft, Amniotic Membrane and Fibrin Glue. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3875.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is a paucity of data regarding the safety of simultaneous double-headed pterygiectomy (SDP). We present a new suture and cautery free technique that uses both conjunctival autograft (CAG) and amniotic membrane graft (AM) over conjunctival defects. We evaluated the outcomes of these SDPs.

Methods : This retrospective study examined the outcomes of 45 consecutive eyes of 43 patients who received SDP by one surgeon (JAM). Patients received 5 mg diazepam and intraoperative local anesthesia, in an office-based operating suite without an anesthesiologist. Pterygia bases were excised, extensive tenonectomy performed, and medial and lateral recti cleaned. The cornea was polished with a diamond burr and Mitomycin C 0.025% was applied for 2 min under the conjunctival edges using 6-8 soaked corneal shields. Over the temporal defect, a CAG measuring 1-2mm greater than the width (W) and anteroposterior (AP) of the defect was placed. A cryopreserved AM (AmnioGraft, Bio-Tissue) was used over the nasal defect. Both grafts were secured with fibrin glue (TISSEEL, Baxter Inc). Cauterization and sutures were avoided. Postoperative complications were recorded.

Results : Of the 45 eyes, 2 were recurrent double headed pterygia at the time of surgery, previously performed by a different surgeon, and 1 eye was a recurrent nasal and primary temporal pterygia. The average nasal and temporal conjunctival defects were 7.4mm (limbal defect, L), 10.8mm (AP) and 11.2mm (W) and 7.3mm (L), 12.6mm (AP), and 12.0mm (W), respectively. One patient’s CAG was supplemented with AM over the remaining temporal defect due to insufficient superior bulbar conjunctiva; this patient did not develop recurrence. The mean follow up time was 39.6 weeks (range 4.6-142.9w). There was 1 nasal recurrence (1.1%) from a primary case at 57w requiring a second CAG. One dellen (1.1%) and 4 granulomas (4.5%) were resolved with topical steroid drops and artificial tears.

Conclusions : To our knowledge, this the largest study of simultaneous double-headed pterygiectomy. The use of conjunctival autograft over the temporal defect, cryopreserved amniotic membrane over the nasal defect, and fibrin glue in SDP eliminates trauma from sequential surgery. This procedure is safe and results in the one of the lowest recurrence rates demonstrated in the literature.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

a) Preoperative double headed pterygium. b) Postoperative outcome at 3 months.

a) Preoperative double headed pterygium. b) Postoperative outcome at 3 months.

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