COMBINED CONJUNCTIVAL AUTOGRAPH TRANSPLANTATION AND AMNIOTIC MEMBRANE OVERLAY IN PTERYGIUM SURGERY

The treatment options of pterygium surgery have been studied for many years but many uncertainties still exist. Conjunctival autograft surgical technique (CAT) is the treatment of choice although there is still a documented high rate of recurrence. Amniotic membrane (AM) anti-inflammatory and analgesic properties can be useful in the reduction of the recurrence rate. The purpose of this study is to show a combined CAT and AM overlay technique as well as the post-operative results in a group of 10 high risk pterygium patients with a minimum follow up of 6 months.

To reduce post-operative recurrence rates after CAT, adjuvants such as mitomycin C and others have been used. Nevertheless they have been associated with higher risk of post-operative severe ocular complications. AM over bare sclera surgical technique has proven to be effective although with a higher rate of recurrence than CAT. We believe that AM documented analgesic properties can reduce pain and accelerate the healing process. Furthermore, AM anti-inflammatory properties can decrease the rates of pterygium recurrence when combined with CAT as an overlay.

Ten high risk of recurrence primary pterygium patients underwent pterygium surgery with the CAT with AM overlay surgical technique. The inclusion criteria for high risk patients were: younger age, darker skin complexion, male sex, outdoor job or leisure activities. After infiltration of the operating sites with lidocaine 2% with adrenaline careful dissection and excision of the pterygium and the surrounding Tenon was performed. A conjunctival epithelium autograft of the same size was removed from the superior bulbar conjunctiva and applied to the bare sclera with fibrin glue. An AM graft was then applied over the conjunctival autograft and secured with 10/10 nylon sutures hidden in the superior and inferior conjunctival fornixes. The eye was then padded for 24h.  Post-operative treatment was initiated on the next day with tobramycin and dexamethasone eyedrops as well as preservative free artificial tears and an eye shield was recommended for protection at night time. Postoperative visits were scheduled at day 1 and 7 and at month 1,3,6 and 12. They included a slit lamp evaluation as well as a pain assessment questionnaire.

None of the patients complained of moderate to severe post-operative pain. Two patients complained of itchiness in the site of the sutures. None of them needed to take painkillers. There were no cases of moderate to severe inflammation. There were no cases of recurrence of pterygium. There was 1 case of a small conjunctival retention cyst

Combined conjunctival autograft transplantation and amniotic membrane overlay technique in pterygium surgery can be effective in the immediate post-operative period by reducing pain as well as in the long term outcomes by reducing the rates of pterygium recurrence. Further randomized controlled trials are needed to prove the benefits of this technique over CAT alone.