Challange In Advanced Recurrent Pterygium And Ocular Surface Reconstructi̇on With Oral Mucosal Graft

Pterygium is one of the most common ocular surface disorders and yet there is no consensus among ophthalmologists on the optimal medical and surgical management. Various surgical techniques have been developed to reduce the recurrence rate. In this report, we recommend oral mucosal grafts for ocular surface reconstruction in advanced pterygium to avoid recurrence.

Akdeniz University Hospital Ophthalmology Department , Antalya, Turkey

A 38-year-old female patient was admitted to our clinic with recurrent pterygium for 10 years. The patient had no known additional disease, history of trauma or chemical exposure, but she had a history of pterygium excision 5 times in her both eyes. While the best corrected visual acuity (BCVA) of the case was 20/50 in the right eye, it was 20/400 in the left eye. Anterior segment examination revealed a central opacity in the right eye, and a recurrent pterygium with nasal symblepharon and central corneal scar in the left eye. Keratoplasty was recommended for the left eye. Prior to keratoplasty pterygium excision and repairing symblepharon with a buccal mucosal graft was performed and the upper fornix was formed. Recurrent pterygium and symblepharon were observed at 4-month follow-up. BCVA was counting fingers at 1 meter. Therefore the patient underwent penetrating keratoplasty. 4 months after surgery, lateral gaze limitation due to symblepharon and recurrent pterygium were observed. Patient underwent a corneal graft and suture preserving pterygium excision, symblefaron release surgery and surface reconstruction with buccal mucosal graft. At the postoperative 18th month, visual acuity was 20/40, minimal limbal vascularization has developed, but no recurrence was observed.

Treatment of recurrent pterygium cases is more difficult than primary pterygium, and it is of great importance to determine the treatment method with the lowest recurrence rate. Mucous membrane grafts are favorable surgical treatment alternatives in advanced recurrent pterygium where conjunctival shortening and symblepharons are present. Even after keratoplasty, recurrent pterygium can occur and buccal mucosa grafting should be considered as a safe and successful procedure.