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LETTER TO EDITOR
Year : 1999  |  Volume : 47  |  Issue : 2  |  Page : 143

Conjunctival limbal autografts for primary and recurrent pterygia


Armed Forces Hospital, PO Box 454, Kuwait

Correspondence Address:
K S Santhan Gopal
Armed Forces Hospital, PO Box 454
Kuwait
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Santhan Gopal K S. Conjunctival limbal autografts for primary and recurrent pterygia. Indian J Ophthalmol 1999;47:143

How to cite this URL:
Santhan Gopal K S. Conjunctival limbal autografts for primary and recurrent pterygia. Indian J Ophthalmol [serial online] 1999 [cited 2019 Nov 19];47:143. Available from: http://www.ijo.in/text.asp?1999/47/2/143/22917

Dear Editor:

With respect to the article "Conjunctival limbal autografts for primary and recurrent pterygia", by Srinivas K. Rao, et al (Indian J Ophthalmol 1998;46:203-209), I wish to make certain points.

I have been using the technique of conjunctival grafting for primary and secondary/recurrent pterygia, for well over two years. I feel that the terminology used by authors for classifying pterygia based on vascularisation into mild, moderate and severe is vague. The degree of vascularization of pterygium is difficult to quantify and is purely subjective. It is not possible to arrive at a uniform system of quantifying the extent of vascularization of the pterygium.

There is also a practical problem in recurrence of pterygia. What is considered a recurrent pterygium? During the post-operative period it is not uncommon to see the blood vessels growing underneath the graft and at the sides of the graft. Though these vessels may not always be visible on simple flash light examination, a careful slitlamp examination will always reveal them. This is true even a few months after the surgery. I feel that a pterygium should be considered as recurrent only when blood vessels are seen growing in a parallel direction towards the limbus; vessels seen in the area of excision pointing in the direction away from the limbus are indicative of a healing process rather than recurrence.

Regarding the graft size, I feel that the size of the graft should be 2 mm more than the size of the bare area of sclera in all directions. Otherwise, the conjunctival graft gets stretched while suturing.

In cases of recurrent pterygia, after the first postoperative week of grafting, when the corneal epithelium has healed and there is no demonstratable fluorescein staining of the cornea and the graft site, I add 0.03% mitomycin C drops twice a day for one week. With this technique the recurrence rate can be reduced significantly.




 

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