| Peer-Reviewed

Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting

Received: 20 September 2021    Accepted: 2 November 2021    Published: 10 November 2021
Views:       Downloads:
Abstract

AIM-To demonstrate intraoperative techniques in managing torn grafts and small grafts in pterygium excision with conjunctival autografting (CAG). METHODS-Fifteen eyes that had graft tear during nasal pterygium excision with CAG and six eyes with small inadequately sized grafts during double head pterygium excision with split conjunctival grafting were included in the study. The graft tears occurred during dissection and the torn grafts were placed as separate pieces to cover the defect completely and in cases of double head pterygia with small graft on one side, a part of the graft from the other side (nasal or temporal) was used to cover the remaining defect. All the grafts were secured using tissue adhesives. RESULTS-Clinical outcomes in all cases were good. The recurrence rate was found to be 4.6%, with recurrence seen in one eye at four months post operatively. Other complications like graft edema and graft necrosis were also similar to those reported in previous literature for routine single head and double head pterygium surgeries. CONCLUSION- In complications like graft tear or small grafts, it is important to utilize the torn graft and part of the other graft in cases of split grafts and carefully resurface the bare area with proper orientation to give an adequate cover, in order to minimize recurrence.

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 4)
DOI 10.11648/j.ijovs.20210604.16
Page(s) 215-218
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pterygium, Conjunctival Autograft, Double Head Pterygium, Graft Tear

References
[1] Li M, Zhu M, Yu Y, Gong L, Zhao N, Robitaille MJ. Comparison of conjunctival autograft transplantation and amniotic membrane transplantationfor pterygium: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2012; 250: 375-381.
[2] Livezenau C, Craitoiu MM, Manescu R, Mocanu C, Craitoiu S. Angiogenesis in the pathology of pterygium. Rom J Morphol Embryol. 2011; 52: 837-844.
[3] Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985; 92: 1461-70.
[4] Bahuva A, Rao SKCurrent Concepts in Management of Pterygium. DJO 2014; 25: 78-84.
[5] Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. Outcome of pterygium surgery: Analysis over 14 years. Eye (Lond) 2005; 19: 1182-90.
[6] Kodavoor SK, Preethi V, Dandapani R. Profile of complications in pterygium surgery - A retrospective analysis. Indian J Ophthalmol 2021; 69: 1697-701.
[7] Hall AB. Understanding and managing pterygium. Community Eye Health 2016; 29: 54-6.
[8] Fernandes M, Sangwan VS, Bansal AK, et al. Outcome of pterygium surgery: analysis over 14 years. Eye. 2005; 19 (11): 1182–1190.
[9] Bilge AD. Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery. Saudi J Ophthalmol. 2018; 32 (2): 110–113.
[10] Koranyi G, Seregard S, Kopp ED. The cut-and-paste method for primary pterygium surgery: long-term follow-up. Acta Ophthalmol Scand. 2005; 83 (3): 298–301.
[11] Ma DH, See LC, Liau SB, Tsai RJ. Amniotic membrane graft for pri-mary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol. 2000; 84 (9): 973–978.
[12] Al Fayez MF. Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 2002; 109 (9): 1752–1755.
[13] Coroneo MT, Di Girolamo N, Wakefield D. The pathogenesis of pterygium. Curr Opin Ophthalmol. 1999; 10: 282–8.
[14] Anguria P, Kitinya J, Ntuli S, Carmichael T. The role of heredity in pterygium development. Int J Ophthalmol. 2014; 7: 563–73.
[15] Ha SW, Park JH, Shin IH, Kim HK. Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery. Int J Ophthalmol. 2015; 8: 522–7.
[16] Kodavoor Shreesha K, Soundarya B, Dandapani Ramamurthy. Comparison of vertical split conjunctival autograft with and without limbus to limbus orientation in cases of double-head pterygium—A retrospective analysis, Indian J Ophthalmol 2020; 68 (4): 573-576.
[17] Jaros PA, De Luise VP. Pingueculae and pterygia. Surv Ophthalmol. 1988; 33: 41–9.
[18] Ma D H, See L C, Liau S B, Tsai R J. Amniotic membrane ghraft for primary pterygium: comparision with conjunctival autograft and topical mitomycin C treatment. Br J Ophthalmol 2000; 84: 973–978.
[19] Luanratanakorn P, Ratanapakorn T, Suwan-apichon O, Chuck R S. Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision. Br. J. Ophthalmol. 2006; 90; 1476- 1480.
[20] Tananuvat N, Martin T. The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft. Cornea. 2004; 23: 458–463.
[21] Gargallo-Benedicto A, Hernández Pérez D, Olate-Pérez Á, Betancur-Delgado E, Cerdà-Ibá˜nez M, DuchSamper A. Large pterygium surgery: When coverage of the scleral bed justifies graft rotation. Arch Soc Esp Oftalmol. 2016.
[22] KwonSH, KimHK. Analysis of recurrence patterns following pterygium surgery with conjunctival autografts. Medicine 2015; 94: e518.
[23] Kodavoor SK, Ramamurthy D, Tiwari NN, Ramamurthy S. Double-head pterygium excision with modified vertically split-conjunctival autograft: Six-year long-term retrospective analysis. Indian J Ophthalmol 2017; 65: 700-4.
[24] Kodavoor SK, Tiwari NN, Ramamurthy D. Long-term analysis of an unconventional way of doing double-head pterygium excision. Oman J Ophthalmol 2019; 12: 166-70.
Cite This Article
  • APA Style

    Shreesha Kumar Kodavoor, Soundarya Balajee, Ramamurthy Dandapani. (2021). Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting. International Journal of Ophthalmology & Visual Science, 6(4), 215-218. https://doi.org/10.11648/j.ijovs.20210604.16

    Copy | Download

    ACS Style

    Shreesha Kumar Kodavoor; Soundarya Balajee; Ramamurthy Dandapani. Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting. Int. J. Ophthalmol. Vis. Sci. 2021, 6(4), 215-218. doi: 10.11648/j.ijovs.20210604.16

    Copy | Download

    AMA Style

    Shreesha Kumar Kodavoor, Soundarya Balajee, Ramamurthy Dandapani. Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting. Int J Ophthalmol Vis Sci. 2021;6(4):215-218. doi: 10.11648/j.ijovs.20210604.16

    Copy | Download

  • @article{10.11648/j.ijovs.20210604.16,
      author = {Shreesha Kumar Kodavoor and Soundarya Balajee and Ramamurthy Dandapani},
      title = {Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {6},
      number = {4},
      pages = {215-218},
      doi = {10.11648/j.ijovs.20210604.16},
      url = {https://doi.org/10.11648/j.ijovs.20210604.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210604.16},
      abstract = {AIM-To demonstrate intraoperative techniques in managing torn grafts and small grafts in pterygium excision with conjunctival autografting (CAG). METHODS-Fifteen eyes that had graft tear during nasal pterygium excision with CAG and six eyes with small inadequately sized grafts during double head pterygium excision with split conjunctival grafting were included in the study. The graft tears occurred during dissection and the torn grafts were placed as separate pieces to cover the defect completely and in cases of double head pterygia with small graft on one side, a part of the graft from the other side (nasal or temporal) was used to cover the remaining defect. All the grafts were secured using tissue adhesives. RESULTS-Clinical outcomes in all cases were good. The recurrence rate was found to be 4.6%, with recurrence seen in one eye at four months post operatively. Other complications like graft edema and graft necrosis were also similar to those reported in previous literature for routine single head and double head pterygium surgeries. CONCLUSION- In complications like graft tear or small grafts, it is important to utilize the torn graft and part of the other graft in cases of split grafts and carefully resurface the bare area with proper orientation to give an adequate cover, in order to minimize recurrence.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Intra-operative Management of Torn Grafts and Small Grafts in Eyes Undergoing Pterygium Excision with Conjunctival Autografting
    AU  - Shreesha Kumar Kodavoor
    AU  - Soundarya Balajee
    AU  - Ramamurthy Dandapani
    Y1  - 2021/11/10
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijovs.20210604.16
    DO  - 10.11648/j.ijovs.20210604.16
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 215
    EP  - 218
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20210604.16
    AB  - AIM-To demonstrate intraoperative techniques in managing torn grafts and small grafts in pterygium excision with conjunctival autografting (CAG). METHODS-Fifteen eyes that had graft tear during nasal pterygium excision with CAG and six eyes with small inadequately sized grafts during double head pterygium excision with split conjunctival grafting were included in the study. The graft tears occurred during dissection and the torn grafts were placed as separate pieces to cover the defect completely and in cases of double head pterygia with small graft on one side, a part of the graft from the other side (nasal or temporal) was used to cover the remaining defect. All the grafts were secured using tissue adhesives. RESULTS-Clinical outcomes in all cases were good. The recurrence rate was found to be 4.6%, with recurrence seen in one eye at four months post operatively. Other complications like graft edema and graft necrosis were also similar to those reported in previous literature for routine single head and double head pterygium surgeries. CONCLUSION- In complications like graft tear or small grafts, it is important to utilize the torn graft and part of the other graft in cases of split grafts and carefully resurface the bare area with proper orientation to give an adequate cover, in order to minimize recurrence.
    VL  - 6
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • Cornea, Cataract and Refractive Services, The Eye Foundation, Coimbatore, India

  • Cornea, Cataract and Refractive Services, The Eye Foundation, Coimbatore, India

  • Cataract and Refractive Services, The Eye Foundation, Coimbatore, India

  • Sections