|Year : 1984 | Volume
| Issue : 3 | Page : 149-151
Rotational grafting of pterygium
Ashok Kumar Sharma, VB Kumar
R.N.T Medical College Udaipur, India
Ashok Kumar Sharma
Raj Bhawan, Behind Head Post Office. Bikaner-334 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma AK, Kumar V B. Rotational grafting of pterygium. Indian J Ophthalmol 1984;32:149-51
Purpose of this study was to evaluate a new surgical technique which can decrease the incidence of pterygium regrowth.
| Material and methods|| |
Under local anaestheia, head of the pterygium is caught by one tooth forceps and a superficial incision in healthy cornea just anterior to the pterygium head is given. A lamellar dissection is done underneath the pterygium and is carried up to the limbus. making the dissection a hit superficial towards limbus. Part of the superficial lamellae of sclera is also dissected so as to make this smooth surface. Pterygium, conjunctiva and Tenon's capsule are undermined towards plica semilunaris for about 6-8 mm. from the limbus. Incision along the upper and lower border of pterygium is made and extended upto 6-8 mm. from the limbus. Then a vertical incision is given so as to join upper and lower incisions, thus a roughly rectangular flap of pterygium is formed [Figure - 1]. Episcleral tissue on bared sclera is picked up and removed.
Now excised roughly rectangular pterygium is rotated in such a way that head of pterygium is facing towards medial canthus and base towards limbus, care is taken that conjunctiva) surface should face up, not towards sclera. Pterygium is sutured in such rotated position with 6-8 interrupted nylon sutures of 8/0 size. Four sutures are applied at corners. One at limbus and if necessary three on upper medial and lower sides respectively [Figure - 2]. No bare sclera is left at limbus. Care should he taken that conjunctiva should not be protuberant at limbus. Cornea and sutured pterygium should make a smooth surface.
Eye is pad and bandaged after putting hydro cortisone eye ointment (Kenalog-s eye ointment) for a day only. Next day dressing is opened and cortisone plus antibiotic (Pyrimon) eye drops 3-4 times a day locally, then gradually reduced in 45 days. Kenalog-S eye ointment at bed time for 15 days is prescribed. Tablet Suganril 2 TDS for 5 days is also given. Sutures are removed on seventh day.
| Observations|| |
This surgical technique was performed in 30 patients and were followed up in 7th, 15th day then monthly up to 3 months.
Ten patients did not come for re-checkup so they were not included in this study. On every visit, degree of inflammation and, any encroachment over cornea was noted. At one and two months check up intraocular tension was also noted.
Out of remaining twenty patients, sixteen cases were of primary pterygiurn and four were recurrences. Site of the pterygium was mostly on nasal side (20 cases) as compared to temporal side (2 cases). Pterygium were divided into three types according to the vascularity, fleshy look and progressiveness (Doherty's morphologico-clinical classification).
Type I is highly vascular, fleshy progressive type (12 cases), Type II is mildly progressive type (6 cases), Type III is regressive type (2 cases).
Age incidence showed that twelve cases were over forty years of age while eight were below forty years of age. Patients who had their follow up for two months at least were included in this study. Duration of follow up was two months in nine cases, more than two months less than six months in five cases and more than six months in six cases. Regrowth/recurrence was seen only in one case [Table - 1].
| Discussion|| |
Aim of this article is to present a surgical technique which in our experience has given excellent results with only one recurrence.
Advantages of the technique are:
1. It can be done as primary technique for pterygium.
2. It can be done in recurrent pterygium also.
3. It can be done in cases where there is excessive scarring due to trachoma or after primary pterygium surgery or in cases of xerosis of conjunctiva.
4. It does not lead to chronic red eye with thick discharge as after mucous membrane grafting.
5. It is a simple technique and can be done even in cases where pterygium is to large.
As specified by different authors the recurrence should be said, when there is encroachment of cornea more than 1 mm by conjunctiva. In this study recurrence was noted in young age group. Most of the pterygia in this study were progressive in nature and recurrence occurred in this group only, which agrees with the findings of other authors. 12,13 Recurrence was seen in primary operated pterygium only, no recurrence occured in cases operated for recurrent pterygium. Most of the authors agree that recurrence of pterygium occurs in first two months only. 3.4.5 We too agree with this as the recurrence in this series occured in first two months, and in such cases the congestion does not disappear.
In this series we have not left any bare sclera but even then the recurrence rate remained to a minimum (5%). In our opinion regrafted rotated pterygium reattaches itself to the globe and acts as a barrier against regrowth. Even the change in the direction of calls may also act in some way against regrowth. The tissue from the same part is more physiological and is better accepted, eye becomes quiet within a short time. Congestion disappears in three weeks completely (except in one case congestion persisted but no recurrence occured till date). Recurrence occured in one case of primary operated pterygium, who did not return for regular check up after 7th day. He came after 2 months when a fibrotic growth of 3 mm was noted encroaching over Cornea, of same size as previous to operation but with fleshy look. Patient did not use medicines prescribed to him regularly.
Some authors have advised mucous membrane graft,,[7 others a sliding flap technique, in cases with recurrent pterygium or in cases where pterygiumn is too large or in cases with excessive scarring of the conjunctive and xerosis but this technique of rotational grafting can be done in all these conditions without taking graft from any other place (mouth). Sliding of flap is not possible in excessive scarring while this surgery can be easily done in these conditions also.
| Summary|| |
Surgical technique of rotational grafting of pterygium with good results and less recurrence rate, is described
| References|| |
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1]