Plasma Technology Instead Of Suture And Glue In Pterygium Removal Surgery With Conjunctival Rotational Flap; A 1 Year Follow Up Case Report

Pterygium is a quasi-triangular and vascular epithelial which grows from nasal side of the eye to cornea. The risk factors that cause pterygium growth could be genetic, age more than 50, UV radiation, Outdoor occupation. Prevalence could be changed by the climate, from 9.1% in hilly regions to 20.3% in coastal regions. Affected patients suffer from astigmatisms, foreign body sensation besides cosmetic disturbing. Pterygium surgery using suture or glue has been reported as the high recurrence rate. Considering that disadvantages of these techniques, we aim to introduce a novel technique using PANIS method (Plasma assisted noninvasive surgery) in pterygium removal surgery with conjunctival rotation flap. 

Two patients (1 male, 1 Female) with grade 3 and 4 of pterygium, based on SLIT2 grading system, underwent examinations to measure parameters including UCVA, BCVA, OSDI and patient satisfaction which were evaluated before, 1 month, 6 months and 1 year after the surgery, as well as 1 day and 1 week post-operation examinations included slit-lamp and external check-up that has been done by the surgeon.

Patients underwent surgery with local anesthesia, removing pterygium tissue from cornea and also all related subtenon. Then surgeon used residual conjunctiva to cover bare sclera using rotational method. Fusion of the border of conjunctival flaps from nasal to superior occurred by plasma spots. Patients with primary pterygium, underwent surgery with PANIS method. Last follow-up session in 1 year, showed significant improvement in astigmatism and 1 line in BCVA. There were no complications and side effects during and after the surgery and also other reported complication included diplopia in lateral gaze, granuloma and scarring was not observed and no recurrence have been seen in the follow-up period and patients were satisfied. Additionally 1 day and 1 week slit-lamp examination showed plasma spots caused good attachment of conjunctival tissue with ocular surface.

After treating 2 patients with PANIS method, it seems that plasma spots can be a good substitute for suture or glue in pterygium surgery with conjunctival rotational flap, because it's easy and fast way for fusing the conjunctival flap without any complication or side effect.