Short-Term Result of Triple Procedure in Pterygium Surgery

Yong Joon Kim; Jin Kwon Chung

doi:10.3341/jkos.2014.55.3.354

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Kim and Chung: Short-Term Result of Triple Procedure in Pterygium Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(3):354-360.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.3.354

Short-Term Result of Triple Procedure in Pterygium Surgery

Yong Joon Kim, MD, Jin Kwon Chung, MD

Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Jin Kwon Chung, MD Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea, Tel: 82-2-709-9354, Fax: 82-2-710-3196, E-mail: schcornea@schmc.ac.kr

Received 27 June 201330 August 2013 Accepted 28 January 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the success and complication rates of triple procedure, including pterygium excision, marginal amniotic membrane insertion beneath the conjunctiva, and limbal-conjunctival autograft in pterygium surgery.

Methods

We conducted a retrospective study on 45 eyes of 45 patients who underwent pterygium surgery between August 2011 and October 2012. After pterygium excision, amniotic membrane was placed beneath the conjunctiva along the margin of the exposed sclera followed by a limbal conjunctival autograft. Success rates, intraoperative and post-operative complications were evaluated.

Results

Forty-three eyes with primary pterygium and 2 eyes with recurrent pterygium were enrolled in the present study. The mean age of the patients was 59.87 ± 14.30 years with a mean follow-up of 12.9 ± 4.6 months. There were no complications during surgery. Early postoperative complications included partial wound dehiscence in 1 eye and a simple conjunctival cyst on the autografted conjunctiva in the another eye. No clinically significant recurrence (G2, G3) was noted during the observational periods. Thirty-nine (86.7%) and 6 (13.3%) eyes were graded as G0 and G1, respectively.

Conclusions

Our surgical technique not only has the benefits of the limbal conjunctival autograft acting as a barrier against fibrovascular invasion of the cornea and supplying stem cells to the corneal epithelium but also has antiangiogenic effects of amniotic membrane with minimal use. In addition, this technique is a safe surgical method in primary and recurrent pterygium.

Keywords: Amniotic membrane, Limbal conjunctival autograft, Pterygium, Triple procedure

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Figure 1.

Representative pictures showing the different stages of pterygium. (A) Stage I: head of pterygium did not reach the midline between the limbus and pupillary margin. (B) Stage II: head of the pterygium passed midline but did not reach the pupil. (C) Stage III: head of the pterygium passed the pupillary margin.

Figure 2.

Surgical steps of triple-procedure in pterygium surgery. (A) Head of pterygium, abnormal proliferative tissue, and subconjunctival fibrovascular tissue were completely removed. (B) Preparation of amniotic membrane to be inserted into the subconjunctival area. (C) Place the amniotic membrane underneath the conjunctiva along the excision margin and fixed with tissue adhesive. (D) Limbal conjunctival autograft with the use of tissue adhesive and 10-0 nylon suture.

Figure 3.

Preoperative (A, B, C, D) and 6 months postoperative (E, F, G, H) anterior segment photographs of patients who had tri-ple-procedure for pterygium.

Figure 4.

Early postoperative complications after triple-procedure in pterygium surgery. (A) Simple conjunctival cyst on autografted conjunctiva (arrowheads). (B) Partial wound dehiscence and amniotic membrane exposure (arrowheads).

Table 1.

Short-term results of triple-procedure in pterygium surgery

Variables
Postop. recurrence grade, N (%)
G0	39 (86.7)
G1	6 (13.3)
G2	0 (0)
G3	0 (0)
Complications, N (%)
Conjunctival cyst	1 (2.2)
Wound dehiscence	1 (2.2)

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