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ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 4  |  Page : 133-134

Kerato-conjunctival graft in recurrent Pterygium


Govt. Med. College, Patiala, India

Correspondence Address:
S L Sharma
Govt. Med. College, Rajendra Hospital, Patiala
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Sharma S L, Singh MM, Manocha M C. Kerato-conjunctival graft in recurrent Pterygium. Indian J Ophthalmol 1979;27:133-4

How to cite this URL:
Sharma S L, Singh MM, Manocha M C. Kerato-conjunctival graft in recurrent Pterygium. Indian J Ophthalmol [serial online] 1979 [cited 2020 Aug 11];27:133-4. Available from: http://www.ijo.in/text.asp?1979/27/4/133/32602

The surgical solution to the problem of the pterygium seems to be deceptively simple. The recurrence rate is alarmingly high. Rate of recurrence varies from 7.7% to 28.5% in primary pterygium and from 40% to 85.7% in recurrent pterygium. Recurrence rates shown by various authors after the commonly accept­ed "Bare-Sclera" varied from 11% to 66% (Youngson, 1972). Among the various methods tried to minimise this high recurrence rate, corneo-conjunctival grafting operations seems to be most promising.

Corneo-conjunctival graft has been used successfully in recurrent pterygia by Durand and Magnard (1970). They had 95.3% success. On the other hand, Youngson (1972) was very much dissatisfied with his results of graft and wanted no surgery in pterygium.

This paper reports on our experience of 20 eyes with recurrent pterygia operated upon with kerato-conjunctival graft.


  Material and Methods Top


The present study is based on the observations made in 20 eyes of pterygium who already had undergone some form of surgery and the growth had reoccured. A portion of the cornea invaded by pterygium was delineat­ed with the help of a corneal trephine opened upto a depth of 0.4 mm and it was dissected with a knife along with the diseased conjunctiva. A peripheral semilunar lamellar donor corneal graft of the same size was taken along with a portion of the conjunctiva attached to the cornea. It was placed on the denuded area of the recepient's eye and stitched with 10-0 virgin silk with interrupted stitches. Stitches removed after 4-6 weeks and the patients followed from 4 months to one year post-operatively.


  Observations and Analysis Top


In the present study on twenty eyes of recurrent pterygia, the average length of the pterygia was found to be 3.52 mm. There were no recurrences and limitation of movements of the globe. Cosmetic results were excellant. In 4 cases (20%), the irritation persisted for more than one week which were treated successfully by corticosteroids. In one case (5%), graft reaction was seen after 3 weeks which however settled down by the use of local and systemic corticoids. In no case either the conjunctival or the corneal graft was rejected.

Mean post-operative change in the hori­zontal meridian in hypermetropic series (11 patients) was an increase of 0.12D and that in the vertical meridian was a decrease of 0.011) (4 months after graft). Similarly in myopic series (9 patients) the horizontal curvature changed by-0.1D and vertical curva­ture by-0.01D. It was observed that kerato­metric readings become fairly stable two or three months after surgery with a change of axis sometimes seen afterwards too. On the whole, it was observed that horizontal corneal curvature showed an increase in eight patients (40%) but declined in six patients (30%). The effect of surgery on vertical curvature was an increase in seven patients (35%) and a decrease in four cases (:0%). In hypermetropic series, the maximum pre-operative corneal astigmatism was found to be 4.00 Dioptre (case No. 19). Average change in astigmatism in this series was from 2.32D to 2.26D, showing mean change to be-0.06D. The change in astigmatism in myopic series was from an average 2.61D to 2.86D. On the whole, astigmatism increased by 0.08 Dioptre from an average 2.45D to 2.53D in total study.

No significant improvement was seen in visual acuity. In thirteen cases (65%, it remained unchanged. It improved in four cases (20°x) but decreased in three cases (15%). No doubt the clarity of cornea was best with this method, yet the increase in corneal astigmatism negated the advantage gained by a clear cornea.

Khalida Naib (1964), Cameron (1965) and others believe that pterygium regrows from the cut edge of conjunctiva, and not from any remanants on cornea. In order to satisfy also I this school of thought, conjunctival graft was applied alongwith. In the present study, home­graft conjunctiva was successfully transplanted alongwith the cornea. Rech (1971) believes that insertion of conjunctival graft along with cornea prevents the growth of conjunctival tissues on to the cornea. This was supported by Durand and Magnard (1970) who applied corneo-conjunctival grafts in 120 cases of recur­rent pterygia with 95.3% success. Another advantage of grafting is that no limitation of movement of medical rectus is seen, a complica­tion likely after other techniques (Dermot Piarsey and Casey, 1959).

Conclusions

Kerato-conjunctival grafting is the best procedure for the treatment of a recurrent pterygium as it prevents further recurrence, gives excellant cosmetic results with no restriction of movement of the globe. Being technically difficult, it is not recommended for the manage­ment of a primary pterygium. In most of the cases there is an increase in astigmatism after kerato-conjunctival graft is applied.




 

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