A long term follow up after limbal conjuctival autograft for. Conjunctival grafts definition of conjunctival grafts by. We evaluated and compared the safety and efficacy of the conjunctivallimbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin c in 94 patients undergoing primary pterygium surgery and concluded that conjunctivallimbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin c. A, preoperative appearance with evidence of extensive symblepharon and adherence of the upper palpebral conjunctiva to the superior cornea. Clinical signs of limbal deficiency include varying combinations of conjunctivalization of the cornea, with associated vascularization and fibrovascular pannus, persistent or recurrent epithelial defects and scarring or stromal haze. Sep 19, 2007 we evaluated and compared the safety and efficacy of the conjunctivallimbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin c in 94 patients undergoing primary pterygium surgery and concluded that conjunctivallimbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin c. Dissection of the conjunctiva, the tenons layer, and the sclera was continued up to the insertion of medial rectus. Combined conjunctival autograft and overlay amniotic.
This random control study included 63 patients 63 eyes with primary pterygium. Extended pterygium removal with extended conjunctival autograft the premise on which this procedure is designed is firstly to reduce the recurrence rate. Limbal conjunctival autograft is currently the most popular surgical procedure as it has been suggested that including the limbal stem cells act as a barrier to the conjunctival cells migrating onto the corneal surface. The features of this surgery that may reduce the recurrence are 1 extensive physical excision of tenons fascia superior, inferior, and nasal to the pterygium and 2 intensive use of. Conjunctival autograft for pterygium johns hopkins university. Pterygium excision combined with a tissue graft has a lower risk of recurrence. The results of our study reporting an advantage of conjunctival autograft over mitomycin c. Limbalconjunctival autograft transplantation for recurrent. Following pterygium excision, the eye is rotated down and in to expose the superior temporal bulbar conjunctiva.
Living related conjunctival limbal allograft for the. Unfortunately, initial therapy after the exposure did not include. Aim to investigate and compare the surgical outcomes of limbal autograft and limbal allograft transplantations in patients with corneal burns. Comparison of wide conjunctival flap and conjunctival. The most common method of autograft fixation is suturing, with drawbacks of prolonged operating time. Combined conjunctival limbal autografts and livingrelated. Thirtynine eyes of the 36 patients with doublehead pterygium excision in the original study 12 years ago were recruited for clinical assessment. In 1985, kenyon et al 1 proposed that a conjunctival autograft of the bare sclera could be used in treatment of recurrent and advanced pterygium.
Dec 05, 2015 pterygium excision with free conjunctival limbal autograft 1. Limbalconjunctival autograft transplantation for the. In this series of patients median followup time was 8 months. Iosr journal of dental and medical sciences iosrjdms eissn. Limbal stem cells and conjunctival autograft transplantation is a safe and effective technique for the treatment of different grades of pterygium. One eye of a patient with chronic total lscd and symblepharon caused by chemical burn was subjected to symblepharon lysis, removal of pannus from corneal surface, am transplantation to cover the conjunctival and corneal surfaces as a permanent graft, one 60 clau to the superior limbal area, and insertion of prokera as a temporary am patch to cover the clau. The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin c mmc with limbal conjunctival autograft for treating recurrent pterygia. Rehmat ali memorial trust hospital, lahore from aug2008 to. Suture less and glue free limbal conjunctival autografting. Sutureless and gluefree conjunctival autograft in pterygium. Limbal versus conjunctival autograft transplantation for.
The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin c mmc with limbalconjunctival autograft for treating. The size of the limbal conjunctival autograft varied from 1. In conjunctival autograft surgery, conjunctival tissue from another part of the persons eye along with limbal tissue is resected in one piece and used to cover the area from which the pterygium was excised. Conjunctival limbal autograft and allograft transplantation. Pterygium surgery with conjunctival autograft, what is this. The mean postoperative follow up was 8 months range. Comparison between sutureless and glue free versus sutured. Pterygium surgery with conjunctival autograft dnatube. The aim of this study was to estimate the efficacy of limbal conjunctival autograft in the treatment of pterygium. Conjunctival limbal autografting a bare sclera after excision of pterygium b conjunctival limbal autograft clau in place. The use of fibrin glue, which has been reported extensively in. Combined clau and lrclal procedures maximize the amount of healthy limbal stem cells with conjunctiva while also minimizing the antigenic burden as all transplanted tissue potentially can be a complete or nearcomplete. Minimal conjunctival limbal autograft for total limbal. Pterygium excision with conjunctival limbal autograft youtube.
First a radial relaxing incision is made in the conjunctiva and tenons capsule and a space is made under the conjunctiva by spreading with the westcott scissors. The conjunctival piece was then excised using a sharp vannas scissors. Conjunctival limbal autograft is the surgical treatment of choice for visually significant unilateral limbal stem cell deficiency. Up next pterygium excision with a conjunctival auto graft using fibrin glue duration. Dec 11, 20 sutured limbal conjunctival autograft was done for patients of group 2 after pterygium excision procedure. Extended pterygium removal with extended conjunctival autograft. The graft included limbal tissue and excluded tenons layer fig. Efficacy of limbalconjunctival autograft surgery with stem. Limbalconjunctival autograft found effective for recurrent. Pterygium surgery with conjunctival autograft risks like with all surgery, complications can occur, such as infection 0. 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. Rehmat ali memorial trust hospital, lahore from aug2008 to may 2011 with a.
Conjunctivallimbal autograft offers a low recurrence rate and fewer complications. Our results are compatible with national and international studies. To report postoperative complications of conjunctival limbal autograft in patients with unilateral total limbal stem cell deficiency lscd. However, there is no clear explanation on the additive successful result of conjunctival limbal autograft that ensured by interaction effect of the grafts with each other or is ensured by pure effect of is. Pterygium excision with free conjunctival limbal autograft. The list of acronyms and abbreviations related to clau conjunctival limbal autograft. These were randomly divided into a group with corneal limbal conjunctival autograft combined with pterygium excision group a and a group with pterygium excision with exposed sclera group b and subjected to longterm follow up.
Conjunctivallimbal autograft for primary and recurrent pterygium. Cautery spots define the area of the conjunctival autograft. This is a case of a 61 yearold man who suffered an alkali burn to his right eye from drain cleaner. With the discovery of the role of limbal stem cells in the maintenance and stability of the corneal surface, recent forms of ocular surface transplantation that have supplanted thofts conjunctival transplantation procedure include limbal autograft transplantation and limbal allograft transplantation. Removal of tenon fortified by conjunctivallimbal autograft. The inclusion of limbal tissue in the conjunctival auto graft following pterygium excision appears to be essential to ensure low recurrence rate.
Clau conjunctival limbal autograft for unilateral limbal. Purposeto determine the efficacy of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture. Purposeto assess the usefulness of limbalconjunctival autograft transplantation lcat for the treatment of recurrent pterygium. Conjunctival autograft transplantation may prevent pterygium. The abnormal scarring tissue on the corneal surface was polished. This video shows how to construct a conjunctival incision that i call the limbal 7. The use of mitomycin c with autologous limbalconjunctival. To describe a simple and effective technique for the prevention of pterygium recurrence.
However failure of these studies to show any difference between mmc and conjunctival autograft. The conjunctival autograft was secured using fibrin glue tisseel vh. In bilateral limbal stem cell deficiency lscd, a limbal allograft transplant utilizing donor tissue from a living relative livingrelated conjunctivallimbal allograft. Jabbarvand et al limbal autograft in primary pterygium iranian journal of ophthalmology volume 19, number 4, 2007 3 mm range. The technique used was excision of pterygium, extending at least 2 mm beyond the limbus, followed by superior conjunctival limbal autograft including limbal stem cells performed in 40 eyes of 31 patients between february and october 2007 at our institution. We compared conjunctival autograft technique and wide conjunctival flap technique in terms of their efficacy, safety, and operation time in the present study. Conjunctivallimbal autograft for primary and recurrent. Patients and methodsseventeen eyes with advanced recurrent pterygium. The study aims to compare the longterm outcome of conjunctival autograft cau and mitomycin c mmc in doublehead pterygium surgery. Oct 02, 2012 pterygium surgery with conjunctival autograft remains the gold standard for reducing recurrence after its initial description in 1985 kenyon, k. Baxter, vienna, austria as described by koranyi et al. Supero temporal free conjunctivolimbal auto graft appears to be a safe and effective technique in the surgical management of pterygium. Comparison of limbal conjunctival autograft with conventional.
Jul 01, 2012 conjunctival limbal autograft is the surgical treatment of choice for visually significant unilateral limbal stem cell deficiency. He was referred one month after the injury with severe inflammation and scarring. Twelveyear outcomes of pterygium excision with conjunctival. Sutured limbal conjunctival autograft simple pterygium excision under local anesthesia was performed then closure of the bare sclera by sutured limbal conjunctival autograft in 100 eyes of 100 patients group 2.
The size of the limbalconjunctival autograft varied from 1. It is useful in prevention of pterygium recurrence, which is a major problem in pterygium surgery. Recurrence of pterygium with conjunctival autograft versus. Conjunctival limbal autograft offers a low recurrence rate and fewer complications. The effect of limbal autograft in recurrence of pterygium. Mar 08, 2017 autoplay when autoplay is enabled, a suggested video will automatically play next. It is very useful in preventing pterygium recurrence, which is a major problem in pterygium surgery. The main difference between the two groups was inclusion of the limbus in the conjunctival autograft in group b. Purposeto assess the usefulness of limbal conjunctival autograft transplantation lcat for the treatment of recurrent pterygium. Technique of pterygium excision with conjunctival limbal autografting is described and the safety and efficacy of the procedure in india is analysed. Pterygium treatment with limbalconjunctival autograft. Pterygium excision with free conjunctival limbal autograft 1.
The study was approved by local ethics committee and conducted in accordance with the ethical principles described by declaration of helsinki. This treatment could be a favored option for managing advanced recurrent pterygia in young highrisk patients. A long term follow up after limbal conjuctival autograft for recurrent pterygium pakistan journal of ophthalmology vol. A pterygium is a fleshy, wingshaped growth from the conjunctiva, crossing over the limbus onto the cornea. Pterygium excision with conjunctival autograft youtube. Limbal autograft and allograft transplantations in patients. Sutured limbal conjunctival autograft was done for patients of group 2 after pterygium excision procedure. Conjunctival limbal autograft clau transplantation is one such technique with low recurrence. Conjunctival limbal autograft clau is indicated for management of symptomatic partial or total unilateral limbal deficiency. Minor ipsilateral simple limbal epithelial transplantation. Certain etiologies of limbal stem cell deficiency also lead to significant conjunctival and goblet cell deficiency. B, same eye 10 months after cadaveric keratolimbal allograft. After administering a 2% lidocaine subconjunctival injection, the donor conjunctiva was harvested with vannas scissors.
Optimal size of pterygium excision for limbal conjunctival. These recurrences are 3 38% following pterygium resection with conjunctival graft placement. Autoplay when autoplay is enabled, a suggested video will automatically play next. This is a retrospective consecutive singlecenter case series with recurrence rate as the main outcome measure. This incision is used for horizontal strabismus surgery. Observation of longterm efficacy of corneal limbal. Although limbal stem cells and conjunctival autograft transplantation is a timeconsuming procedure, it is a safe and effective technique for the treatment of different grades of pterygium. This is a followup study of a comparative interventional trial. This prospective, randomized study found that limbalconjunctival autograft transplant is safe and more effective than free conjunctival autograft transplant in preventing recurrence after excision of recurrent pterygia p 0.
The maintenance of a healthy functional corneal epithelium under both normal and traumatic conditions is provided by a unique subpopulation of stem cells at the limbal region. Limbalconjunctival autograft is currently the most popular surgical procedure as it has been suggested that including the limbal stem cells act as a barrier to the conjunctival cells migrating onto the corneal surface. Download citation limbal conjunctival autograft in pterygium surgery. A limbalconjunctival autograft was taken from the superolateral side of the same eye and transferred to the area where pterygium was excised. Comparison of limbal conjunctival autograft with conventional bare sclera technique 630 p j m h s vol.1482 1177 596 719 642 1408 797 1041 181 222 1119 287 805 980 1462 817 180 1313 654 442 989 157 1264 825 1437 783 219 1444 1232 109 1001 923