A Case of Conjunctival Autotransplantation Using Conjunctival Flap of Pterygium in Treating Corneal Ulcer Perforation

PURPOSE: To report a case of conjunctival autotransplantation using the conjunctival flap of the pterygium for thetreatment corneal ulcer perforation. CASE SUMMARY: A 72-year-old woman was referred to our hospital because her left eye had a corneal ulcer due topine needle trauma, and she did not respond to the initial therapy in a private clinic for 1 week. We first applied topical and systemic antibiotics. However, the lesion did not subside, and necrosis progressed in the stroma at the center of the cornea. On day 6 of admission, perforation was found at the center of the cornea, and we excised the necrotic tissue and performed bilateral pedicle conjunctival flap transposition. After the operation, an ischemic change was observed, and in the fourth week perforation occured at the center of the transplanted conjunctival flap. Because we considered it difficult to perform the transplantation of a conjunctival flap in the left eye, we performed autotransplantation on the corneal perforation in the left eye using conjunctival flap obtained through a pterygium excision in the right eye. After the operation, vascular ingrowth started from the edge of the flap, and there were no symptoms of inflammation, shrinkage, or necrosis of the flap. During the follow-up observation, the flap survived well without necrosis.

A Case of Conjunctival Autotransplantation Using Conjunctival Flap of Pterygium in Treating Corneal Ulcer Perforation

PURPOSE: To report a case of conjunctival autotransplantation using the conjunctival flap of the pterygium for thetreatment corneal ulcer perforation. CASE SUMMARY: A 72-year-old woman was referred to our hospital because her left eye had a corneal ulcer due topine needle trauma, and she did not respond to the initial therapy in a private clinic for 1 week. We first applied topical and systemic antibiotics. However, the lesion did not subside, and necrosis progressed in the stroma at the center of the cornea. On day 6 of admission, perforation was found at the center of the cornea, and we excised the necrotic tissue and performed bilateral pedicle conjunctival flap transposition. After the operation, an ischemic change was observed, and in the fourth week perforation occured at the center of the transplanted conjunctival flap. Because we considered it difficult to perform the transplantation of a conjunctival flap in the left eye, we performed autotransplantation on the corneal perforation in the left eye using conjunctival flap obtained through a pterygium excision in the right eye. After the operation, vascular ingrowth started from the edge of the flap, and there were no symptoms of inflammation, shrinkage, or necrosis of the flap. During the follow-up observation, the flap survived well without necrosis.

The Use of Fibrin Glue for Conjunctival Autotransplantation in Pterygium

PURPOSE: To investigate the efficacy of fibrin glue for conjunctival autotransplantation in pterygium. METHODS: Forty eyes of 32 patients who underwent conjunctival autotransplantation for primary pterygium with a minimum follow-up period of 6 months were included. Postopertive pain, foreign body sensation, tearing, subconjunctival hemorrhage, surgery time, complication, and recurrence were evaluated prospectively in 20 eyes of 15 patients undergoing surgery with fibrin glue, and in 20 eyes of 17 patients undergoing surgery with sutures. RESULTS: One day postoperative, the scores of pain (P<0.01), foreign body sensation (P<0.01), tearing (P<0.01), and subconjunctival hemorrhage (P=0.01) were significantly lower in the fibrin glue group than in the suture group. One week postoperative, the scores of foreign body sensation (P=0.01) and tearing (P=0.01) were significantly lower in the fibrin glue group than in the suture group. Mean surgery time in the fibrin glue group (18 8 minutes) was significantly shorter than in the sutures group (32 11 minutes) (P<0.01). There was no significant difference in the recurrence rates of the two groups. CONCLUSIONS: Use of fibrin glue for conjunctival autotransplantation in pterygium can reduce postoperative discomfort and required surgical time.

Conjunctival Mini-flap Technique and Conjunctival Autotransplantation in Pterygium Surgery

PURPOSE: To compare postoperative recurrence rates between conjunctival autotransplant ation and the conjunctival mini-flap technique in pterygium surgery and to identify factors associated with postoperative recurrence. METHODS: In a retrospective survey of patients who underwent pterygium surgery between March, 2001 and February, 2004 at Severance Hospital, 49 eyes with pterygium removed by the conjunctival mini-flap technique and 41 eyes that underwent pterygium removal surgery by the conjunctival autotransplantation technique were studied. RESULTS: During the mean follow-up period of 8.79 3.9 months, recurrence of pterygium was observed in 3 of 49 eyes (7.1%) that received the conjunctival mini-flap technique. There were 9 recurrent cases out of 41 eyes (21.9%) that were treated by the conjunctival autotransplantation technique. There was no statistical significance between recurrence rate and age, sex, or previous operation in either of the respective surgical techniques. CONCLUSIONS: This study showed that the conjunctival mini-flap technique has a lower recurrence rate than the conjunctival autotransplantation technique. We also found that the conjunctival mini-flap technique is an effective and safe technique that does not generally cause serious complications.