COMBINED SUTURELESS AMNIOTIC MEMBRANE TRANSPLANTATION WITH NARROW STRIP CONJUNCTIVAL AUTOGRAFT FOR PTERYGIUM

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COMBINED SUTURELESS AMNIOTIC MEMBRANE
TRANSPLANTATION WITH NARROW STRIP CONJUNCTIVAL
AUTOGRAFT FOR PTERYGIUM

• Meltem Yagmur MD
• Nese Cetin MD
• T. Reha Ersoz MD
• Ahmet Dogan MD
• Ayse Tandogan MD
• CUKUROVA UNIVERSITY, FACULTY OF MEDICINE
• DEPARTMENT OF OPHTHALMOLOGY
• ADANA / TURKEY
• Authors have no financial interest

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• PURPOSE
• 1- To study the efficacy and safety of
  combined sutureless amniotic membrane
  transplantation with narrow strip conjunctival
  autograft
• 2- To investigate the clinical outcomes
  including the surgery duration, the size of
  pterygium and conjunctival autograft,
  postoperative complications, subjective
  complaints and recurrences
• DESIGN
• Non-randomised prospective study

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• MATERIALS-1
• Between June 2007- February 2008, 30 eyes of 30
  patients with primary pterygia were treated with
  excision followed by sutureless amniotic membrane
  transplantation combined with narrow strip
  conjunctival autograft with fibrin glue
• The patients were examined at the first
  postoperative day 1st week 1st, 3rd, 6th and
  12th months

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• MATERIALS-2
• SURGICAL TECHNIQUE
• All surgical procedures were performed by the
  same surgeon (MY) under peribulbar anaesthesia
• After extensive excision of the pterygium
• 1- A free autograft of 2mm wide was obtained from
  superotemporal bulbar conjunctiva 5 mm away from
  limbus, was prepared for the limbal part of the
  bare sclera
• 2- An amniotic membrane graft was cut into the
  same size of the defect and was prepared for the
  conjunctival side of the bare sclera
• Both grafts were secured with fibrin glue
• Postoperatively, topical 0.3 ofloxacin 5x1 and
  1 prednisolone 5x1 were given

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• MATERIALS-3
• At each follow-up visit
• 1- Localization of the grafts,
• 2- Presence of subconjunctival hemorrhage,
• 3- Subjective complaints pain, watering,
  stinging, foreign body sensation
• were recorded

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• RESULTS-1
• 30 patients 14 ?, 16 ?
• The mean age was 54.313.0 years
• The mean pterygium size was 3.120.92 mm
• The mean size of the conjunctival autograft was
  7.531.45 mm
• The mean conjunctival reconstruction time was
  4.581.10 minutes
• The mean follow-up was 11 months

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• RESULTS-2
• At the first day the graft was dislocated at one
  patient
• Eight of the patients had subconjunctival
  hemorrhage (Figure 1)

Figure 1. Localized subconjunctival hemorrhage at
the first postoperative day
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Table 1

• The complaints were consisted of pain, stinging
  and foreign body sensation (Table 1)

COMPLAINTS Absent Mild Moderate Severe
Pain 8 (26.7) 14 (46.7) 6 (20.0) 2 (6.7)
Foreign body sensation 25 (83.3) 3 (10.0) 2 (6.7) -
Stinging 9 (30.0) 17 (56.7) 3 (10.0) 1 (3.3)
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• RESULTS-3
• At 1st week
• One patient had subconjunctival hemorrhage
• Twenty-nine patients (96.7) had no
  complaint
• Twenty-eight (93.3) patients had no recurrence
  (Figure 2)

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2b
2a
Figure 2. The preoperative and postoperative
clinical pictures of a patient without recurrence
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CONCLUSIONS

• The combined sutureless amniotic membrane
  transplantation with narrow strip conjunctival
  autograft is an effective procedure with low rate
  of recurrence
• This technique can be considered as a preferred
  grafting procedure for primary pterygium