Journal of Refractive Surgery

Sliding Flap of Conjunctival Limbus to Prevent Recurrence of Pterygium

Teofilo Tomas, MD

Abstract

ABSTRACT

BACKGROUND: Several techniques have been advocated for the excision of a pterygium: bare sclera, conjunctival flaps, free conjunctival graft, and labial mucous membrane graft.

METHODS: Twenty eyes were treated with a sliding flap of limbal conjunctiva into the scleral bed of the excised pterigium, using 7-0 and 8-0 Vicryl sutures. Corticosteroids and tear substitutes were administered postoperatively.

RESULTS: There was one recurrence in the 20 eyes performed with 1 year follow up.

CONCLUSIONS: Recurrence was limited to that of 5% (1 case out of 20). Postoperative inflammatory reaction was minimal. [Refract Corneal Surg 1992;8:394-395.)

Abstract

ABSTRACT

BACKGROUND: Several techniques have been advocated for the excision of a pterygium: bare sclera, conjunctival flaps, free conjunctival graft, and labial mucous membrane graft.

METHODS: Twenty eyes were treated with a sliding flap of limbal conjunctiva into the scleral bed of the excised pterigium, using 7-0 and 8-0 Vicryl sutures. Corticosteroids and tear substitutes were administered postoperatively.

RESULTS: There was one recurrence in the 20 eyes performed with 1 year follow up.

CONCLUSIONS: Recurrence was limited to that of 5% (1 case out of 20). Postoperative inflammatory reaction was minimal. [Refract Corneal Surg 1992;8:394-395.)

Recurrence of a pterygium after excision is a matter of concern among ophthalmologists.1,2 Multiple techniques have been advocated to reduce this incidence of recurrence, including beta irradiation fa 20% recurrence), topical Thio-tepa, and mitomycin-Cp 3, none of which are completely satisfactory.

Many techniques have been described by numerous authors for the removal of a pterygium and prevention of recurrence:

1. Bare sclera (King, McGavic, Pico),4 pterygium transplantation (King, Nehrer, Desmarres, Berens, Knapp, Callahan, Blascovics).4

2. Excision of pterygium with conjunctival flaps (Terson, ArIt, Czarmark, Arruga, Bauferter, Campodonico,4 Anduze).3

3. Pterygium removal followed by a free conjunctival graft (Riss, Lemoine, Tarrero, Domínguez, Simmons, Tatasabar, Lemimken,4 Kenyon);4,5 labial mucosa has also been used.6

4. Burying the head of the pterygium beneath the conjunctiva (Knapp).6

5. Transposition of the pterygium to near the inferior rectus (McReynolds).6

6. Excision of pterygium with 90-degree rotation of the square flap (Spaeth).6

MATERIALS AND METHODS

Twenty eyes were treated with this technique (8 males and 10 females), two with bilateral pterygia. Ages ranged from 24 to 68 years. Surgery was done on those eyes in which pterygium extended at least 3 mm onto the cornea. The technique is illustrated in the Figure. Postoperatively, tear substitutes and topical corticosteroids (1 week) were used; 7-0 and 8-0 Vicryl sutures were used and were removed after 10 to 14 days.

FIGURE: Sliding conjunctival flap technique for pterygium excision. (A) Pterygium is excised, and remaining peripheral conjunctiva is closed. (B) Arcuate incisions parallel and approximately 4 mm from the limbus are created. (C) Parallel arcuate incisions are made at the limbus to free up the sliding limbal conjunctival flap. (D) Absorbable sutures are passed through the flaps obliquely, to pull them toward the bed of the excised pterygium. The ends of the flaps are sutured together, and remaining conjunctiva closed.

FIGURE: Sliding conjunctival flap technique for pterygium excision. (A) Pterygium is excised, and remaining peripheral conjunctiva is closed. (B) Arcuate incisions parallel and approximately 4 mm from the limbus are created. (C) Parallel arcuate incisions are made at the limbus to free up the sliding limbal conjunctival flap. (D) Absorbable sutures are passed through the flaps obliquely, to pull them toward the bed of the excised pterygium. The ends of the flaps are sutured together, and remaining conjunctiva closed.

RESULTS

Twenty cases of primary pterygium underwent surgery with this technique with only one recurrence (5%) at 1 year. Patients had a very comfortable postop course, probably due to the restitution of the anatomy in the area of the excision.

REFERENCES

1. McDonnell P. External diseases. Audio digest. Ophthalmology. 1989;27:17-05.

2. Cameron ME. Pterygium Throughout the World. Charles Thomas; 1965: 4-6.

3. Anduze AL. Merest sclera technique for primary pterygium surgery. Ophthalmic Surg. 1989;20:892-894.

4. King JH, Wadsworth JAC. An Atlas of Ophthalmic Surgery. 2nd ed. Philadelphia, Pa: JB Lippincott, Co; 1970: 222-235."

5. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985;92:1461-1470.

6. Arruga H. Ocular Surgery. Translated from 4th ed by Hogan MJ, Chapparro LE, Salvat Editores, SA, 1956: 316-331.

10.3928/1081-597X-19920901-13

Sign up to receive

Journal E-contents