Abstract
Purpose :
Pterygium excision with autograft has become a preferred technique among ophthalmologists due to the relatively low recurrence rate [Akbari, 2022]. Optimal outcomes require that both the limbal and apical orientations of the autograft be preserved. If the apical surface of the autograft is inverted, the graft will undergo necrosis [Kaufman et al., 2000]. If the limbal-fornix orientation of the graft is inverted, early post-operative graft edema can ensue [Starck et al., 1991]. We developed and tested a simple surgical tool, named the Savage Stamp, for marking both the apical and limbal surfaces of a conjunctival autograft to ensure proper autograft orientation during pterygium surgery.
Methods :
Four porcine globes were obtained (Joe’s Meat Market, Ontario, NY, USA). A ~7-mm diameter autograft was marked with the Savage Stamp (Epsilon USA, Inc., Chino, CA, USA) using invisible, UV light ink. Four third year ophthalmology residents each dissected the autograft from a single globe under UV light. Each resident then sequentially dropped the autograft from a height of ~1-foot and attempted to replace it on the globe with the correct apical and limbal orientation without the use of the UV light. This was done for ten trials. UV light was used to verify the graft orientation after each trial. The same task was then repeated ten times after the autograft was marked with the Savage stamp using visible ink. The results were compared using a Student’s t-test. The Savage Stamp was also used for a pterygium excision with autograft by an attending ophthalmologist who then shared their experience with the instrument.
Results :
On average, the proportion of times participants successfully repositioned the porcine autograft in the correct apical-limbal orientation was 0.4 ± 0.2 without the Savage Stamp. When the Savage Stamp was utilized, all participants consistently achieved correct repositioning with a proportion of 1.0 ± 0.0. The attending physician's feedback on the Savage Stamp in the operating room highlighted a negligible impact on case time and an increased confidence in ensuring autograft orientation.
Conclusions :
Malpositioned autografts in pterygium surgery may lead to complications. The Savage Stamp, a simple tool aiding proper graft orientation, could reduce post-operative issues. Its potential extends to marking amniotic membrane grafts. Further experience is required to fully understand its utility.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.