Comparison of Miniflap and Rotational Conjunctival Flap Techniques of Pterygium Accompanied by Conjunctivochalasis

Ji Sang Min; Longyu Jin; Yoon Hyung Kwon; Woo Chan Park

doi:10.3341/jkos.2018.59.9.810

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Min, Jin, Kwon, and Park: Comparison of Miniflap and Rotational Conjunctival Flap Techniques of Pterygium Accompanied by Conjunctivochalasis

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(9): 810-818.

Published online: 17 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.9.810

Comparison of Miniflap and Rotational Conjunctival Flap Techniques of Pterygium Accompanied by Conjunctivochalasis

Ji Sang Min, MD, Longyu Jin, MD, Yoon Hyung Kwon, MD, Woo Chan Park, MD, PhD

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea.

Address reprint requests to Woo Chan Park, MD, PhD. Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro Seo-gu, Busan 49201, Korea. Tel: 82-51-240-5222, Fax: 82-51-240-2776, wcpark@dau.ac.kr

Received 21 September 2017 Revised 20 January 2018 Accepted 28 August 2018

The Korean Ophthalmological Society

(open-access):

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 investigate the differences between the recurrence and cosmesis of the miniflap technique and rotational conjunctival flap technique using redundant conjunctiva tissue in pterygium patients accompanied by conjunctivochalasis.

Methods

This retrospective clinical study included 48 patients diagnosed with pterygium and conjunctivochalsis: 27 pterygium patients who underwent surgery using the miniflap technique and 21 pterygium patients who underwent surgery using the rotational conjunctival flap technique with redundant conjunctiva tissue. The recurrence of each operation, defined as fibrovascular invasion of the cornea, was analyzed. Redness was compared using Image J software to resolve the red color ratios with respect to the red, green, and blue colors of the pterygium excision site. The difference in the red color ratio before and after surgery was analyzed with each surgery.

Results

For patients who underwent the miniflap technique, the mean age was 66 years, the recurrence rate was 5.1%, the mean follow-up period was 12 months, and the average recurrence was 5 months after surgery. For patients who underwent the rotational conjunctival flap technique using redundant conjunctiva tissue, the mean age was 62 years, the recurrence rate was 5.9%, the mean follow-up period was 20 months, and the average recurrence was 5 months after surgery. The ratio of the red color after surgery decreased 5.3% in the miniflap technique group and 6.1% in the rotational conjunctival flap technique group. Between the two groups, there was no significant difference in the recurrence or redness after surgery.

Conclusions

The rotational conjunctival flap technique using redundant conjunctiva in patients with pterygium and conjunctivochalasis was useful for reducing recurrence and cosmesis.

Keywords: Chalasis, Cosmesis, Miniflap, Pterygium, Surgery

Figures and Tables

Figure 1

The surgical procedure of modified miniflap technique using amniotic membrane transplantation. (A) A small conjunctival flap was made (dotted line) before fibrovascular tissues of pterygium (thin lines) excision. (B) The pterygium head and body were excised, and subconjunctival fibrovascular tissue was removed (area of thin lines surrounded with dotted line). (C) Amniotic membrane is placed over exposed sclera, and was sutured (dark area), and small conjunctival flap was placed over amniotic membrane transplantation area (area of thin lines surrounded with thick line). (D) The small conjunctival flap was transposed to pterygium excision area over amniotic membrane transplantation site (area of thin lines).

Figure 2

The surgical procedure of rotational conjunctival flap technique with redundant conjunctiva tissue. (A) The pterygium head and body were excised (area of thin lines surrounded with dotted line). (B) The redundant conjunctiva of temporal area (area of dotted line) was excised. Conjunctival flap was made with remained redundant conjunctiva (thick line). (C) Amniotic membrane is placed over exposed sclera of pterygium excision, conjunctival flap, and redundant conjunctiva excision site and was sutured (dark area). (D) The conjunctival flap (area of dotted line) was transposed to pterygium excision area (area of thin lines) over amniotic membrane transplantation site (dark area).

Figure 3

The rotational conjunctival flap technique of pterygium surgery accompanied with conjunctival chalasis. (A) Before surgery, dotted line shows conjunctival chalasis. (B) After pterygium excision, temporal area of redundant conjunctiva was excised. And conjunctival flap was made with remained redundant conjunctiva. After conjunctival flap was made, amniotic membrane transplantation was done on the exposed sclera of pterygium excision, conjunctival flap, redundant conjunctiva excision site. And conjunctival flap was transposed to pterygium excision site (dotted line).

Figure 4

Anterior segment photographs of miniflap technique. (A) Anterior segment photography before miniflap technique. (B) Postoperative 6 months in patients received miniflap technique.

Figure 5

Anterior segment photographs of conjunctival flap technique. (A) Anterior segment photography before conjunctival flap technique accompanied with conjunctival chalasis. (B) Postoperative 6 months in patients received rotational conjunctival flap technique using redundant conjunctiva.

Figure 6

Anterior segment photographs of pterygium recurrence. (A) Anterior segment photopraphy shows recurrence after pterygium surgery. Recurrence after pterygium surgery was defined when fibrovascular tissue invaded cornea (yellow arrow). (B) Anterior segment photography shows corneal neovascularization after pterygium surgery (yellow arrow).

Figure 7

The Photographs show red-green-blue (RGB) analysis of Image J program. RGB analysis was applied on the operation site except the cornea area (yellow lined area).

Table 1

Baseline demographics of the patients

Values are presented as mean ± SD unless otherwise indicated.

^*Statistically significance is p < 0.05 Mann-Whitney U-test; ^†Statistically significance is p < 0.05 Fischer's exact test.

Table 2

Comparison between two groups of recurrence and corneal neovascularization after surgery

Values are presented as mean ± SD or n (%) unless otherwise indicated.

^*Statistically significance is p < 0.05 Mann-Whitney U-test; ^†Statistically significance is p < 0.05 Fischer's exact test.

Table 3

Comparison of red ratio between two groups using Image J

Values are presented as mean ± SD unless otherwise indicated.

^*Statistically significance is p < 0.05 Mann-Whitney U-test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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