Conjunctival Autograft versus Combined Amniotic Membrane and Mini-Simple Limbal Epithelial Transplant for Primary Pterygium Excision

Abstract

Purpose: To compare outcomes of conjunctival autograft (CAG) and combined amniotic membrane with mini-simple limbal epithelial transplant (mini-SLET) after primary pterygium excision.
 Methods: All consenting adults with primary pterygium were included in this study. After pterygium excision, patients were randomized to receive either CAG or mini-SLET and both grafts were held in place with fibrin glue. The patients were followed-up at days 1, 3, 7, 14, and 30 and subsequently at the third, sixth, and ninth months. The recurrence rate was considered as the primary outcome measure whereas the operating time, postoperative symptoms, and surgical complications were considered the secondary outcome measures.
 Results: The study comprised of 264 eyes of 264 patients, of which 233 (88%) completed the nine months of follow-up. Of these, 118 (51%) received CAG and 115 (49%) received mini-SLET. The groups were comparable at baseline. Recurrence of pterygium was seen in two (1.6%) eyes in the CAG group and three (2.6%) eyes in the mini-SLET group (P = 0.68). Operative time for mini-SLET (20.33 ± 1.28 min) was significantly higher than that for CAG (12.01 ± 1.26 min) (P < 0.001). Graft displacement was observed in one case in group II (P = 0.999). The Lim Bon Siong (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was statistically significant for all four symptoms at days 1 and 3; however, on day 7, foreign body sensation, pain, and irritation scores were significantly higher for the CAG group.
 Conclusion: In this study, the overall recurrence rate was very low and comparable between mini-SLET and the established technique of CAG after performing the primary pterygium excision. Despite a longer surgical time, mini- SLET appears to be a viable option for the management of primary pterygium.

Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review

“…In 2011, Taylan et al prospectively followed 30 patients with primary pterygia treated with excision followed by an inlay AMG to cover the conjunctival side of the bare sclera combined with a narrow-strip CAT to cover the limbal part of the bare sclera; both tissues were fixated using fibrin-glue tissue adhesive (recurrence rate 6.67%) [ 58 ]. Other surgical techniques have also been described, including CAT with an overlay cryopreserved or lyophilized AMG (recurrence rates of 7.10% and 3.00%, respectively); mini simple limbal epithelial transplantation followed by an overlay AMG (recurrence rate of 2.50%); and more recently, LCA and dehydrated AMG inserted into a subconjunctival pocket created around the periphery of the excision site in 493 eyes (recurrence rate of 1.20%) [ 36 , 59 – 61 ].…”

Use of Cryopreserved Amniotic Membrane During Pterygium Excision: Health Economic Analysis

“…All studies were randomized controlled trials aside from four prospective comparative studies. [10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,[14][15][16][17][18][19][20] six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus.…”

“…Of 796 eyes/cases that underwent pterygium excision and CAU with fibrin glue, the weighted average duration of surgery was 23.6 minutes (Table 1). 11,12,[14][15][16][17][18][19][20][21][22][23][24][25] Twelve studies reported the surgical duration for CAU with sutures, with an average operative time of 38.1 minutes among 640 eyes (Table 2). 10,[12][13][14][15][16][17][18][19][20]26,27 previously reported, the average operative time for pterygium excision using the TissueTuck technique is 14.7 minutes.…”

Autologous Serum for Fixation of Limbal Conjunctival Autograft in Primary Pterygium Surgery

“…2 To prevent recurrence many other techniques are available, such as use of mitomycin C (MMC), beta irradiations, amniotic membrane graft and conjunctival Autograft after bare sclera technique. [3][4][5] Limbal conjunctival Autograft is another technique to prevent recurrence of pterygium. 6 This technique was first described by Kenyon et al 7 It is much more challenging in terms of surgical expertise and proper graft orientation.…”