ESCRS - FP11.11 - Surgical Management Of Pterygium Invading The Corneal Flap After Laser In Situ Keratomileusis: A Retrospective Case Series

Surgical Management Of Pterygium Invading The Corneal Flap After Laser In Situ Keratomileusis: A Retrospective Case Series

Published 2025 - 43rd Congress of the ESCRS

Reference: FP11.11 | Type: Free paper | DOI: 10.82333/f6rv-qw45

Authors: Juan Arbelaez* 1 , Rosa Basim Dhamadawi 2 , Jimmy Hernandez 3 , Samrat Panda 2 , Thomas Magnago 4 , Maria Clara Arbelaez 1

1Cornea and Refractive Surgery,Muscat Eye Laser Center,Muscat,Oman, 2Optometry,Muscat Eye Laser Center,Muscat,Oman, 3Operating Theatre,Muscat Eye Laser Center,Muscat,Oman, 4SCHWIND eye-tech-solutions GmbH,Kleinostheim,Germany

Purpose

Pterygium is a common ocular surface disorder, with a prevalence of 1.2%–23.4%. Despite the large number of patients undergoing laser in situ keratomileusis (LASIK), reports on pterygium following LASIK are scarce. Since the LASIK-created corneal flap lacks suture fixation, it might be susceptible to displacement by external forces such as trauma or surgical intervention. In this study, we evaluated the surgical outcomes of pterygium excision with pedicle conjunctival flap transplantation in cases where the pterygium encroached on the LASIK flap.

Setting

This retrospective case series was conducted at Nihon University Itabashi Hospital (Tokyo, Japan) between November 2021 and February 2025.

Methods

Four eyes of four patients (three men and one woman; mean age, 52.8 ± 5.1 years) underwent pterygium excision with pedicle conjunctival flap transplantation. To minimize LASIK flap displacement during surgery, we implemented several precautions, including performing tension-free excision from the lesion head to the body, avoiding upward traction during tissue manipulation, and using intraoperative fluorescein staining to assess resection depth and smoothness.

Results

The mean follow-up period was 12.48 ± 16.06 months. The mean corrected visual acuity (LogMAR) remained stable at -0.15 ± 0.04 both preoperatively and postoperatively. The mean corneal astigmatism improved from 3.33 ± 2.54 D to 1.11 ± 0.31 D. The mean higher-order aberrations (HOAs) of the anterior corneal surface (6 mm) changed from 3.21 ± 2.38 μm to 0.99 ± 0.23 μm (p= 0.16). Those of the posterior corneal surface (6 mm) changed from 0.22 ± 0.11 μm to 0.12 ± 0.02 μm (p= 0.20). No significant difference was detected between preoperative and postoperative HOAs in anterior and posterior corneal surface. In Case 2, the pterygium recurred 21 months postoperatively, requiring the secondary operation. The postoperative course was favorable.

Conclusions

Pterygium excision with pedicle conjunctival flap transplantation was successfully performed in four cases of pterygium invading the LASIK corneal flap. Meticulous surgical techniques, including careful lesion excision and intraoperative assessment of resection depth, are crucial in preventing flap displacement and associated complications. Even in the case where recurrence occurred, favorable outcomes were achieved with secondary transplantation, including superficial keratoplasty, intraoperative mitomycin C application, and amniotic membrane transplantation.