Extended pterygium removal with extended conjunctival. The bss was placed to remove some excess conjunctival debris. Pterygium is a wing shaped fleshy mass occurring at nasal side of conjunctiva and if not managed on time can cover pupil area and visual impairment which finally may results to blindness. Conjunctival autograft transplantation for advanced and recurrent pterygium. I had surgery to remove a ptyerigium in my left eye using conjunctival autograft exactly a week ago. Preventing conjunctival autograft inversion in pterygium. Optimal size of pterygium excision for limbal conjunctival autograft. Matt ward, md pterygium surgery with conjunctival autograft remains the gold standard for reducing recurrence after its initial description in 1985 kenyon kr, wagoner md hettinger me.
Probably the most common use of limbal autografts has been in surgery for pterygium in the form of an ipsilateral limbal translocation, though there is little evidence that the limbal part of the autograft adds any benefit over a standard conjunctival autograft. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. Kenyon describes his surgical technique of pterygium excision with conjunctival autograft transplantation, detailing the method that was developed at. A picture of the patient after 1 month is also incorporated in the video.
Conjunctival autografting was more likely to produce an improvement in visual acuity than other forms of surgery. Mean followup time in the autograft group and the zplasty group was 18 and 17 months, respectively. Rapuano, md, director of the cornea service at wills eye institute explains pterygium excision with a conjunctival auto graft using fibrin glue. Pterygium excision with free conjunctival limbal autograft doi. Pterygium removal dr chris hornsby ophthalmology medical. Sutureless and gluefree conjunctival autograft in pterygium surgery tukaram ranbaji gitte, hanumant tulsiram karad, mayur kulkarni, azeem. The free conjunctival autograft is harvested from the superior bulbar conjunctiva of the same eye. The pterygium was excised using a combination of blunt and sharp dissection on the corneal side. The same measurements are marked on the donor site with a gentian violet marking pen. Lidocaine with epinephrine is injected to balloon the pterygium and conjunctiva to make dissection easier. Comparison of limbal conjunctival autograft with conventional.
Management of pterygium american academy of ophthalmology. Pterygium excision with conjunctival autograft on vimeo join. Oct 31, 2017 impact of conjunctival autograft on pterygium treatment. Your browser does not currently recognize any of the video formats available. This video demonstrates the importance of careful dissection to the root of the pterygium rather than simply excising the pterygium flush to the plica. Unfortunately, this led to a high rate of pterygium regrowth.
Pterygium excision with free conjunctival limbal autograft. Jun 9, 2015 how is surgery to remove a pterygium performed. Pterygium surgery mountain view peninsula laser eye. Firstly, the dimensions of the bare sclera after excision of the pterygium are measured with the castroviejo calipers fig 1b 1b and with the eye in abduction. In conclusion, combination of conjunctivaperimuscular connective tissue complex and muscle surgery is required to improve ocular alignment and motility in subjects with incomitant esotropia following pterygium excision surgery. Like with all surgery, complications can occur, such as infection 0. Refer to your surgery schedule for dates and times.
Pterygium excision and conjunctival autograft is a surgical procedure which involves. To compare the outcomes of free conjunctival autograft cau versus conjunctivallimbal autograft clau in the prevention of recurrence after pterygium surgery with adjunctive mitomycin c. Kenyon describes his surgical technique of pterygium excision with conjunctival autograft transplantation, detailing the method that was developed at the massachusetts eye and. Conjunctival autografting in the surgical management of. Several complications can result from pterygium surgery. There is a 10% possibility of the pterygium recurring, if it is highly developed, and can. Limbal stem cell transplantation is the better of the choices in preventing recurrence of pterygium as compared to other treatment modalities and thus can be safely recommended for pterygium surgery. To evaluate the safety and effectiveness of conjunctival rotation autograft technique in preventing the recurrence of primary pterygium. Conjunctival autograft for pterygium johns hopkins university.
More research is needed to determine which type of surgery resulted in better vision or quality of life. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free. Sutures are used to anchor the graft, then glue is appli. Please return to our office for your postoperative visit as directed. They quoted a probability of recurrences of 14% with this procedure at 36 months after surgery. Pterygium surgery with conjunctival autograft dnatube. Corneal reepithelialization was achieved in 60 hours after surgery. A pterygium can occur in both eyes, usually on the nasal side of the eye. Comparison of wide conjunctival flap and conjunctival. Recurrence of pterygium with conjunctival autograft versus.
Surgical removal is the treatment of choice, but recurrence of pterygium is a. Pterygium, limbal conjunctival autograft introduction pterygium is a fibro vascular overgrowth of. This surgery is done under peribulbar anaesthesia with good orbicularis oculi akinesia. Various techniques of conjunctival transplantation have been used to manage pterygium. Pterygium excision with a conjunctival auto graft using fibrin glue. In this technique, the pterygium is removed, and the cornea regains clarity. Pdf pterygium excision with conjunctival autografting. Comparison of conjunctival autograft and conjunctival.
A video recording of 35 seconds duration was initiated with the first appearance of the dye. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use. Pterygium surgery using a conjunctival autograft is associated with recurrence in 5% of cases. Pterygium surgery with conjunctival autograft with no sutures and no glue steps. Pterygium excision with conjunctival autograft on vimeo. A comparison between surgical techniques for securing conjunctival autografting in primary pterygium surgery the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Feb 11, 2016 pterygium is a wing shaped fleshy mass occurring at nasal side of conjunctiva and if not managed on time can cover pupil area and visual impairment which finally may results to blindness. Based on recurrence rates, the current optimal surgical management appears to be conjunctival autograft surgery. In this prospective study, 24 eyes of 24 consecutive.
The additional use of mitomycin c is of unclear effect. Reexcision of the pterygium with conjunctival autograft and concomitant application of mitomycin c 0. Pterygium removal with conjunctival autograft and mitomycin c. Because the superior bulbar conjunctiva is usually normal and undamaged due to reduced exposure to ultraviolet light and chemical irritants, conjunctival autograft tissue can be obtained from this area in the same eye. A comparison between surgical techniques for securing conjunctival autografting in primary pterygium surgery. Pterygium evulsion surgery with no stitch no glue autograft. Once the advancing head is excised, there is a relaxing effect on the nasal conjunctival tissue.
Results showed that the effect of wide conjunctival flap techniques on primary pterygium surgery was found close to the conjunctival autograft techniques. Pterygium surgery with conjunctival autograft risks like with all surgery, complications can occur, such as infection 0. Visual outcome and efficacy of conjunctival autograft. Hence pterygia usually occur in patients living in hot climates such as the indian subcontinent, africa and australia. Sutureless and gluefree conjunctival autograft in pterygium surgery tukaram ranbaji gitte, hanumant tulsiram karad, mayur kulkarni, azeem mashayak, gauri kulkarni department of opthalmology, mimsr medical college, vishwanathpuram, ambajogai road, latur maharashtra received. We also discuss our experience regarding the patient acceptability, visual results, and potential complications in a 6month followup period with this new technique. In traditional bare sclera pterygium removal, the underlying white of the eye is left exposed. Oct 02, 2012 pterygium surgery with conjunctival autograft remains the gold standard for reducing recurrence after its initial description in 1985 kenyon, k.
Pterygium surgery with autoconjunctival graft by dr ben. A conjunctival autograft is generally considered the. A comparison between surgical techniques for securing conjunctival autografting in primary. 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. Dec 05, 2015 pterygium excision with free conjunctival limbal autograft doi. These days special interest has been generated ever since someone found out that a conjunctival autograft can stick to the bare sclera bed without the aid of any sutures.
Conjunctival autograft transplantation may prevent. Pterygium excision procedure manchester eye surgery. Pterygium excision with conjunctival autograft youtube. The older, standard surgical technique left a bare hole in the conjunctiva the surface of the eye where the pterygium was removed. The technique demonstrated in this video makes use of tisseel fibrin glue to anchor the graft in the bed. Surgical steps of pterygium excision, conjunctival autograft harvesting.
Using conjunctival autograft and prophylactic subconjunctival placement of amniotic membrane. The recurrence rate following surgery is low, ranging from 5% to 10%. Preventing conjunctival autograft inversion in pterygium surgery. Feb 05, 20 pterygium surgery with conjunctival autograft remains the gold standard for reducing recurrence.
Next, the corneal surface was smoothened using a crescent blade and a burr. Postoperative instructions for pterygium removal conjunctival removal osr special instructions. A pterygium pronounced terigium is a triangular shaped lump of tissue, which grows from the conjunctiva the thin membrane that covers the white of the eye onto the cornea clear central part of the eye. Todays techniques offer a significantly higher success rate than conventional surgery. Since removing the eye patch the day after the surgery, my vision in the operated eye has been very blurred.
Incomitant esotropia following pterygium excision surgery. This video describes the basic surgical principles of pterygium surgery. The conjunctival defects after pterygium excision were repaired in 21 eyes with conjunctival autograft and in 27 eyes with conjunctival transpositional flaps. Pterygium excision with a conjunctival auto graft using. Surgery is effective in improving the primary position deviation, though some restricted abduction may persist. Pterygium excision with conjunctival autograft eyetube. Cauterisation versus fibrin glue for conjunctival autografting in. A comparison of anchored conjunctival rotation flap and. Technique of pterygium excision with conjunctival limbal autografting is described and the safety and efficacy of the procedure in india is analysed. Cutandplace technique of pterygium excision with autograft without.
Optimal size of pterygium excision for limbal conjunctival. However, in this study, we report outcomes with a novel technique of the pterygium management using conjunctival autograft harvested from the body of the pterygium. Healing of autologous conjunctival grafts in pterygium surgery. Impact of conjunctival autograft on pterygium treatment.
In the present study, we aimed to compare the wide conjunctival flap and the conjunctival autografting techniques in pterygium surgery according to time of operation, safety, and effectiveness. Extended pterygium removal with extended conjunctival autograft. In this photo, the pterygium has an associated conjunctival cyst, which is even more likely to interfere with lubrication of the ocular surface surgery involves careful removal of the pterygium from the cornea and adjacent nasal conjunctiva. Sutures are used to anchor the graft, then glue is applied to affix the tissue in place. A comparison of two conjunctival rotation autograft. A comparison between surgical techniques for securing. John hofbauer, md, and nicole fram, md, present a case of pterygium excision in a 38year old hispanic male using conjunctival autograft, fibrin glue, mitomycin 0. The apparent success of this procedure suggests that the transfer of limbal stem cells is not a primary reason for the success of conjunctival grafting in pterygium surgery. Conjunctival autografting in the surgical management of pterygium skip to main content. Pterygium surgery with conjunctival autograft, what is. 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.
After the graft was noted to be sealed, stay sutures were removed. Conjunctival autograft for pterygium johns hopkins. This produces dramatic changes in the autograft for which patients should be counselled before surgery. Most corneal specialists today perform pterygium surgery with a conjunctival autograft because of a reduced risk of recurrence.
The glue was placed underneath the graft, so it may seal appropriately. Pterygium removal surgery eliminates the abnormal tissue from the cornea and sclera white of the eye. Using a scissors to cut the pterygium from the adjacent conjunctiva using a scissors or blade to excise the pterygium from the corneal surface. In conclusion, we proposed an optimal size of excision, intraoperative mmc and conjunctival autograft with fibrin glue in order to standardize graft sizes, simplify pterygium surgery, and reduce rates of incorrectly sized grafts. I am very concerned as i had 2020 vision prior to the surgery and now i cannot make out anything except very large bold text. It was excised with westcott scissors on the conjunctival side. This will seemingly increase the area to be removed, and the surgeon may inadvertently end up excising a larger area surgical management of pterygium guillermo rocha, m.
Rapuano, md, director of the cornea service at wills eye institute explains pterygium excision with a conjunctival auto graft. Pterygium typically arises from the inner nasal conjunctiva and is strongly associated with ultraviolet light uv exposure. Patch will be removed at your postoperative appointment. Extended pterygium removal with extended conjunctival autograft the premise on which this procedure is designed is firstly to reduce the recurrence rate.
To compare the outcomes of free conjunctival autograft cau versus conjunctival limbal autograft clau in the prevention of recurrence after pterygium surgery with adjunctive mitomycin c. A video of pterygium surgery with conjunctival autograft with no sutures and no glue was done about a month back. Conjunctival autografts in pterygium surgery follow a consistent healing pattern dominated by re. It was concluded that pterygium surgical excision with conjunctival autograft is effective in pterygium surgery. Cohen, md, phd, presents a technique for conjunctival autograft for pterygium. A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery sung hyun kim, jong hyun oh, jae rock do, roy s. Pterygium surgery involves removal of the abnormal tissue from the sclera and cornea of the eye. Pterygium excision combined with a tissue graft has a lower risk of recurrence. Pterygium surgery with conjunctival autograft, what is this.
Conjunctival rotation autograft for primary pterygium. Sutureless and gluefree conjunctival autograft in pterygium. We advocate the use of cra for cases of pterygium in which a conventional autograft is contraindicated or difficult. Blurred eyesight after pterygium surgery eye care medhelp. Pterygium surgery with autoconjunctival graft by dr ben limbu. The surgery is sutureless, using fibrin adhesive to secure the conjunctiva. Sutureless and gluefree conjunctival autograft in pterygium surgery. Forty two consecutive patients had undergone pterygium excision with either conjunctival autografting or conjunctival zplasty randomly. Pterygium excision w conj autograft, no sutures, no glue.
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