J Korean Ophthalmol Soc JKOS Journal of the Korean Ophthalmological Society 0378-6471 2092-9374 The Korean Ophthalmological Society 10.3341/jkos.2012.53.2.215 Original Article Effectiveness of Wide Excision of Subconjucntival Fibrovascular Tissue with Conjunctivo-Limbal Autograft in Pterygium Surgery Bae Sung Geun MD Lee Jin Ki MD PhD Park Dae Jin MD Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea. Address reprint requests to Dae Jin Park, MD. Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-gu, Daegu 701-600, Korea. Tel: 82-53-940-7140, Fax: 82-53-954-7417, djoph2540@yahoo.co.kr 02 2012 15 02 2012 53 2 215 222 25 05 2011 23 11 2011 Copyright © 2012 The Korean Ophthalmological Society 2012 Purpose

To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium.

 Methods

Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated.

 Results

With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 ± 6.9 minutes) was significantly shorter than that in the wide excision group (62.4 ± 6.2 minutes).

 Conclusions

Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia.

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Classification of pterygium. (A) Grade T1 (atrophic) episcleral vessels are unobscured. (B) Grade T2 (intermediate) episcleral vessels are partially obscured. (C) Grade T3 (fleshy) episcleral vessels are totally obscured.

Grading of recurrence after pterygium surgery. (A) Grade 0, normal appearance of the operated site. (B) Grade 1, fine episcleral vessels in the excised area. (C) Grade 2, fibrovascular tissue in the excised area, reaching to the limbus, but not invading the cornea (conjunctival recurrence). (D) Grade 3, fibrovascular tissue invading the cornea (corneal recurrence).

Complications of donor site after conjunctivo-limbal autograft pterygium surgery. (A) Scarring. (B) Neovascularization. (C) Wound gapping (arrow). (D) Granuloma. (E) Retention cyst.

Post-operative complications. (A, B) Post-operative sub-graft hemorrhage. (C) Graft edema after conjunctivo-limbal autograft.

Characteristics of patients

SD = standard deviation; PT = pterygium.

*Underwent excising of subconjunctival fibrovascular tissue; †Didn't undergo excising of subconjunctival fibrovascular tissue; ‡Grading system by Tan et al.3

Comparison of complications and operating time according to the surgical method

SD = standard deviation.

*Underwent excising of subconjunctival fibrovascular tissue; †Didn't undergo excising of subconjunctival fibrovascular tissue; ‡Measured by Wilcoxon signed rank test.