Long-term Outcomes of Conjunctivolimbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

In Kwon Chung; Jin Hyoung Kim; Jong Hyun Lee; Do Hyung Lee

doi:10.3341/jkos.2018.59.12.1114

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Chung, Kim, Lee, and Lee: Long-term Outcomes of Conjunctivolimbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

Original Article

J Korean Ophthalmol Soc 2018;59(12):1114-1121.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.12.1114

Long-term Outcomes of Conjunctivolimbal Autograft Alone and Additional Widening of Limbal Incision in Recurrent Pterygia

In Kwon Chung, MD, Jin Hyoung Kim, MD, PhD, Jong Hyun Lee, MD, PhD, Do Hyung Lee, MD, PhD

Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Address reprint requests to Do Hyung Lee, MD, PhD Department of Ophthalmology, Inje University Ilsan Paik Hospital, #170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7240, Fax: 82-31-911-7241 E-mail: eyedr0823@hotmail.com

Received 6 September 2018 Revised 21 November 2018 Accepted 30 November 2018

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

We report the clinical outcomes of patients undergoing additional widening of the limbal incision to prevent disease recurrence after conjunctivo-limbal autograft combined with pterygial excision.

Methods

We retrospectively compared 95 eyes with primary and 12 eyes with recurrent pterygia randomized to treatment via two surgical methods: conjunctivo-limbal autograft alone and combined with widening of the limbal incision to allow for pterygial removal. We widened the limbal incisions by 1 mm on both the superior and inferior limbal margins and removed the pterygia. The outcomes were compared between 39 eyes undergoing conjunctivo-limbal autograft alone and 68 eyes undergoing conjunctivolimbal autograft with widening of the limbal incision.

Results

The mean overall postoperative follow-up period was 29.6 ± 10.5 months and conjunctivo-limbal autograft alone group was 27.4 ± 11.5 months, combined with widening of the limbal incision group was 30.7 ± 9.7 months. Six pterygia (15.4%; four primary and two recurrent) developed in those undergoing conjunctivo-limbal autograft alone and two (2.9%; one primary and one recurrent) in those undergoing additional widening of the limbal incision; the recurrence rate differed significantly between the two groups (p < 0.05). In the group treated with conjunctivo-limbal autograft alone, the mean time to development of a new primary pterygium was 6.3 ± 3.4 months and that to development of a recurrent pterygium 4.3 ± 2.5 months; the respective values for the group undergoing additional widening of the limbal incision were 12.1 ± 2.6 and 8.4 ± 4.6 months; the recurrence rates differed significantly (p < 0.05).

Conclusions

Conjunctivolimbal autograft with additional widening of the limbal incision used to treat both new primary and recurrent pterygia was more effective in terms of reducing pterygial recurrence than conjunctivo-limbal aAutograft alone.

Keywords: Limbal, Pterygium, Recurrence, Transplantation, Widening

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Figure 1.

Surgical technique of conjunctivo-limbal autograft combined with widening of the limbal incision in pterygium. (A) Pterygium incision area was marked by Gentian violet and the area where pterygium's body met limbus was also marked by Gentian violet to locate additional widening of limbal incision area. On each superior and inferior margin of limbus where the pterygium was removed. (B) Fibrovascular tissues that built up on the exposed sclera surface were removed sufficiently using Westcott scissor and #15 blades to eliminate any residuals in limbus. (C) Extra 1 mm incision was carried out in the additional widening limbal incision area where it was marked in (A). (D) After suture of both margins of limbus, 10–0 Nylon was grafted by interrupted suture and then fixation suture was carried out in episclera parallel to limbus to prevent grafted area from moving.

Figure 2.

The preoperative and postoperative photographs of patients who have pterygium with conjunctivo-limbal autograft alone and combined with widening of the limbal incision. (A, B) Preoperative anterior segment photos of pterygium. (C) Postoperative 6 months after conjunctivo-limbal autograft alone. (D) postoperative 6 months after conjunctivo-limbal autograft combined with widening of the limbal incision.

Table 1.

Characteristics of patients

	Conjunctivolimbal autograft alone (n = 39)	Combined with widening of the limbal incision (n = 68)	p-value^*
Age (years)	64.15 ± 9.47	63.46 ± 12.47	0.763
Follow up period	27.4 ± 11.5	30.7 ± 9.7	0.683
Gender (male:female)	18:16	26:35	0.334
Primary:recurrence	37:2	58:10	0.242

Values are presented as mean ± standard deviation unless otherwise indicated.

^* Mann-Whitney U test; statistically significant (p < 0.05).

Table 2.

Comparison of recurrence rates and time to recurrece in patients with pterygium using conjunctivo-limbal autograft alone and combined with widening of the limbal incision

	Conjunctivolimbal autograft alone (n = 39)	Combined with widening of the limbal incision (n = 68)	p-value
Primary	4/37	1/58	0.049^*
Mean time to recurrence (months)	6.3 ± 3.4	12.1 ± 2.6	0.000^†
Recurrent	2/2	1/10	0.045^*
Mean time to recurrence (months)	4.3 ± 2.5	8.4 ± 4.6	0.000^†
Total	6/39	2/68	0.049^*
Mean time to recurrence (months)	5.5 ± 3.1	10.6 ± 3.4	0.000^†

Values are presented as mean ± standard deviation unless otherwise indicated.

^* Fisher exact test: statistically significant (p < 0.05)

^† Mann-Whitney U test: statistically significant (p < 0.05).

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