Pentagonal Vs Quadrangular Conjunctival Autograft In Pterygium Surgery: A Comparative Study On Graft Retraction

Postoperative complications such as suture dehiscence, graft retraction, and graft displacement—particularly at the nasal edge—are common following pterygium surgery. Conventional techniques employ a rectangular conjunctival autograft placed on a rectangular recipient bed; however, the spherical curvature of the globe may generate increased tension at the central nasal margin during ocular movements, predisposing to graft instability. This study aimed to evaluate whether modifying the nasal edge of the autograft into a convex configuration, forming a pentagonal shape, reduces graft retraction and displacement.

Single-center, tertiary care hospital (Diskapi Yıldırım Beyazıt Training and Research Hospital)

This retrospective comparative study included patients who underwent primary pterygium excision with conjunctival autograft transplantation using either a pentagonal or conventional quadrangular graft configuration. Only primary pterygium cases with at least 6 months of postoperative follow-up were included. Patients with systemic or ocular conditions affecting wound healing were excluded. All surgeries were performed by a single experienced surgeon using sutured fixation. The primary outcome was graft retraction. Secondary outcomes included graft displacement requiring resuturing and recurrence rate.

Fifty-eight eyes were included: 26 in the pentagonal graft group and 32 in the quadrangular graft group. Graft retraction occurred in 1 eye (3.8%) in the pentagonal group compared with 9 eyes (28.1%) in the quadrangular group (P=0.015). No graft displacement requiring resuturing occurred in the pentagonal group, whereas 4 cases (15.6%) were observed in the quadrangular group (P>0.05). Recurrence rates were 7.6% and 12.5% in the pentagonal and quadrangular groups, respectively, without statistical significance.

A pentagonal conjunctival autograft configuration significantly reduces graft retraction after pterygium surgery compared with the conventional quadrangular design. By improving conformity to the globe’s curvature and distributing traction forces more evenly, this geometric modification may enhance graft stability and represent a simple, effective surgical refinement.