Abstract
Purpose :
It is well known that the rate of unsuccessful trabeculectomy (TRAB) is higher in patients who underwent surgical procedures involving conjunctival transfixion. In this study, we evaluate the healing evolution of conjunctiva and Tenon after autografting used in pterygium excision.
Methods :
Eleven eyes who underwent pterygium excision and local reconstruction with autografting from upper conjunctiva were included.The autograft was obtained avoiding the injury of Tenon’s capsule and healing of the conjunctiva occurred by second intention.
The donor area was analyzed by anterior segment optical coherence tomography (AS-OCT) and by digital photography taken in slit-lamp before and 180 days after the pterygium excision. We performed measurements of conjunctiva and Tenon thicknesses at 12 o'clock 3 mm away the limbus. After 6 months postoperative, patients were evaluated by three surgeons (two glaucoma experts and one retina expert) We have asked them to evaluate: change in the radial path of the vessels, evidence of delimitation of the donor area, mobility to the touch with cotton swab of the conjunctiva/Tenon and viability for TRAB. For statistical analysis, we use the Paired-t test for comparison the pre and postoperative thickness means of conjunctiva (epithelium and stroma) and Tenon.
Results :
At 180 days, no significant differences were found by AS-OCT measurements in pre and postoperative thicknesses means of conjunctiva (epithelium: preop = 51.00±6.09µm vs postop = 48.20±6.25µm; P = 0.40; conjunctival stroma thickness: preop = 96.00±18.73µm vs postop = 100.60±23.65µm; P = 0.451 and Tenon’s capsule: pre = 124.20±20.16µm vs postop = 119.50±18.67µm; P = 0.376).
Experts evaluation reported alteration in the radial pattern of the vessels and evidence of demarcation of the removed graft was observed in 11.1% of patients. They noted preservation of conjunctiva-Tenon mobility and viability for TRAB in all patients.
Conclusions :
Tenon's capsule preservation during surgical procedures using conjunctival graft allowed the regeneration of the conjunctival epithelium and stroma without compromising structure and mobility tissue and without fibrosis at the procedure site. Thus, the reliability for a surgical reintervention on the spot is warranted.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.