APR 02, 2013
Cornea/External Disease
This prospective, randomized study found that limbal-conjunctival autograft transplant is safe and more effective than free conjunctival autograft transplant in preventing recurrence after excision of recurrent pterygia (P = 0.004). This treatment could be a favored option for managing advanced recurrent pterygia in young high-risk patients.
The study included 205 advanced recurrent pterygia patients randomized to free conjunctival autograft transplant or limbal-conjunctival autograft transplant who completed the follow-up visits. The patients were a high-risk population composed of mainly young men. Mean follow-up was 62 months.
Ten patients (10 percent) in the conjunctival autograft group and one patient (1 percent) in the limbal-conjunctival autograft group developed recurrence. This difference was statistically significant (P = 0.004).
The authors note that the only recurrence in the limbal-conjunctival autograft group followed a severe attack of adenoviral keratoconjunctivitis three months after the surgical procedure. The recurrent pterygium’s size remained stationary at less than 1.5 mm, a size some investigators do not count as a true recurrence.
They say that the only concern with including limbal tissue in the conjunctival graft is the possibility of inducing iatrogenic limbal stem cell deficiency at the site of the limbal graft. However, no signs of limbal stem cell deficiency were observed during follow-up, which was consistent with other studies.
The other concern they mention is the operating time. Although it was not significantly different between the two procedures, each of them takes longer compared with some other techniques. However, operating time can be significantly reduced by using fibrin glue instead of sutures for fixing the graft tissue.
They conclude that the limbal-conjunctival autograft method provides good cosmetic results and avoids vision-threatening complications associated with the use of adjunctive therapies, such as mitomycin C.