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Outcomes of conjunctival-limbal autograft in three eyes with primary pterygium. Each row shows a case documented preoperatively, 1 and 6 months after surgery . on September 23, 2023 by guest. Protected by copyright.
Source publication
Purpose
The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival–limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision of pterygium.
Methods
Eligibility criteria for participants was the presence of a primary nas...
Context in source publication
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Aims
This study aimed to report corneal steep island (CSI) formation following primary pterygium surgery and to identify preoperative pterygium morphological features that predict the likelihood of CSI.
Methods
A total of 93 eyes from 84 subjects with primary nasal pterygium, who underwent pterygium excision combined with conjunctival-limbal autog...
Citations
... Although recent studies have reported the mechanism and diagnosis of pterygium, surgical suture modalities remain to be further explored [14][15] . Currently, limbal conjunctival autograft is considered the gold standard for the management of primary pterygium owing to its reduced recurrence rate and fewer complications [16][17][18][19] . Various methods have been reported to fix the limbal conjunctival autograft, including routine sutures, autologous serum adhesion, fibrin glue, biological glue and corneal bandage lenses [18,[20][21][22][23] . ...
AIM: To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation. METHODS: Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability. RESULTS: Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min vs 18.15±2.20min, P=0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) vs 3.00min (2.21-4.15), P<0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (P<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) vs 2 (1-4), P<0.001]. Postoperative symptoms at 6mo were comparable between the groups (P=0.487), with no recurrence. CONCLUSION: ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.
Approaches to limbal stem cell deficiency remain challenging, especially in bilateral cases, where healthy limbal stem cells are not accessible. While living-related allogeneic and allogeneic limbal stem cell sources have been utilized, their dependence on immunosuppression and its associated side effects pose significant limitations. Mucosal and mesenchymal stem cells have shown potential for differentiation into limbal stem cells and promoting corneal healing, primarily when cultured on the amniotic membrane or fibrin. However, none can fully replicate the original limbus. Innovations in surgical techniques, such as simple oral mucosal transplantation and subconjunctival or intrastromal mesenchymal stem cell injections, are emerging approaches. For successful limbal regeneration, both appropriate cells and suitable scaffolds are essential. Recent studies on decellularized and acellularized limbus models have demonstrated the potential to provide a three-dimensional native structure for cell seeding, retention, and differentiation. Creating a thin, evenly decellularized scaffold is a critical step in ensuring proper corneo-limbal slope formation, facilitating cell migration to the ocular surface. Harvesting the limbus, decellularization, and cell seeding are the three main steps in limbal reconstruction. Recent studies focus on microkeratome-assisted limbal harvesting to create a thin, even, and 360-degree limbal graft. This technique helps form an attached corneo-limbal interface, facilitating limbal stem cell migration. In the second step, acellularization is performed to preserve the extracellular matrix as much as possible, maintaining hemostasis and supporting paracrine interactions. The final steps involve recellularization and transplantation onto the eye. We summarize various limbal decellularization methods, their outcomes, and their potential in limbal reconstruction. More clinical studies are needed to validate this phase of limbal deficiency treatment.
Background/Objective:
To compare the risk of recurrence and disease-free time after conjunctival autograft (CAG) or conjunctival-limbal autograft (CLAG) with sutureless (fibrin glue) fixation for pterygium excision.
Subjects/Methods
This is a retrospective cohort study. We reviewed the charts of 312 patients who underwent CAG and CLAG sutureless techniques between 2010 and 2019. Follow-up included visits on the 1st day, at weeks 1, 4, and 3, 6, 9, and 12 months after surgery, and every two years afterwards. The primary outcomes were the overall recurrence rate and average time to recurrence. The secondary outcomes were the rates of postoperative complications and the operation duration. Multivariate logistic regression was performed to verify the potential independent predictors of the study outcomes.
Results
265 patients were included, with a mean follow-up time of 31.5 months (maximum 8 years). The pterygium recurrence rate was significantly lower in the CLAG group at 12 months (3.9% vs. 17.4%, p < 0.001) and at the end of the follow-up (4.6% vs. 18.2%, p < 0.001). Patients with CLAG also had a longer time to recurrence (8.8 vs. 4.8 months, p = 0.012). The complications rate was lower for CLAG (0.6% vs. 10.6%, p < 0.002), while no clinically relevant differences were found in the surgery duration (23.4’ for CLAG vs. 25.2’ for CAG). Multivariate analysis confirmed these bivariate results.
Conclusions
Compared with CAG, CLAG reduced the risk and time to pterygium recurrence. Owing to the comparable surgical time and better safety profile, the CLAG technique can be considered a clinically and cost-effective approach for pterygium management.
