Pterygium Recurrence After Excision and Conjunctival Graft Fixation With Tissue Adhesive

Abstract

Abstract: : Purpose: Evaluation of pterygium recurrence rate and patient satisfaction after surgical excision with autologous autograft transplant using fibrin tissue adhesive Methods: A retrospective chart review of twenty–five patients that had undergone pterygium excision and autologous conjunctiva transplant with tissue adhesive between the months of April 2004 and August 2004 was performed. Patients who had proper post operative follow up for a total of three months were selcted. Total of ten eyes of ten patients were included in the study. Pterygium recurrence rates and patient satisfaction were analyzed. Results: Nine of the ten patients evaluated were satisfied with the cosmetic outcome and denied any discomfort. One patient had pterygium recurrence (> 1mm of corneal invasion) in the area of the graft and was not satisfied with the cosmetic appearance. This patient had more glue applied at the time of surgery compared to the others. Nine out of ten had no recurrence in the area of the graft and were satisfied with the cosmetic outcome. Three of the nine presented a small regrowth of fibrovascular tissue inferiorly and at the margin of the graft. These were not causing symptoms of discomfort and were only evident on slit lamp magnification Conclusions: Tissue adhesive is a proper alternative for graft placement during pterygium surgery with advantages of less surgical time and patient discomfort. Although tissue adhesive has become more popular, pterygium recurrence rates after surgery have not been documented. One of our patients showed recurrence in the area of the graft. Recurrence may be accounted by the improper alignment of the graft with the native conjunctiva and /or the excess of adhesive placed in the bed. Despite surgical success, some small fibrovascular strands may find alternate routes and grow towards the cornea, as was seen in three patients. They are not considered recurrences since they are were not visually or cosmetically significant (less than 1mm of corneal invasion) and were not causing discomfort. This may have occurred secondary to any possible gaps between the graft and the native conjunctiva. Successes rates may vary depending on the proper placement of the graft and amount of adhesive applied therefore, surgical experience add proper techniques are necessary. Long term follow up needs to be assessed.

Keywords: Pterygium • conjunctiva • clinical (human) or epidemiologic studies: outcomes/complications