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

 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

 MATERIALS-1 Between June 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

 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

 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

 RESULTS-1 ♂  30 patients; 14 ♀, 16 ♂  The mean age was 54.3±13.0 years  The mean pterygium size was 3.12±0.92 mm  The mean size of the conjunctival autograft was 7.53±1.45 mm  The mean conjunctival reconstruction time was 4.58±1.10 minutes  The mean follow-up was 11 months

 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

Table 1  The complaints were consisted of pain, stinging and foreign body sensation (Table 1) COMPLAINTSAbsentMildModerateSevere Pain8 (26.7%)14 (46.7%)6 (20.0%)2 (6.7%) Foreign body sensation 25 (83.3%)3 (10.0%)2 (6.7%)- Stinging9 (30.0%)17 (56.7%)3 (10.0%)1 (3.3%)

 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)

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

 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