Reducing postoperative pterygium recurrence: comparison of free conjunctival auto-graft and conjunctival rotation flap techniques

ABSTRACT

To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Quasi-experimental study. Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of >/= 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group [n=26] cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group [n=31] cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences [SPSS] version 20. The median [and inter-quartile range] age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 [51.50 - 63.00] and 57 [45.00 - 60.00] years, 28.50 [27.00 - 30.50] and 16.00 [15.00 - 17.00] minutes respectively. Recurrence was seen in 2 [7.96%] and 3 [9.76%] cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups [p=0.60]. The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and complications are comparable