1. Surgical Result of Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation (P.E.R.F.A.M.T)
Wei-Li Chen, MD, PhD Associate Professor, National Taiwan University Hospital Director, Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital

2. Financial Disclosure
The authors have no commercial proprietary interest in the products or companies mentioned here

3. Prevention of Recurrence after Pterygium Surgery
Adjunctive procedures: Mitomycin C application, β irradiation, amniotic membrane transplantation, conjunctival transplantation
Other surgical factors: the EXTENT of Tenon's layer removal underneath conjunctival edge

4. Extended Removal of Tenon's Layer

5. P.E.R.F.A.M.T
Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation

6. P.E.R.F.A.M.T Surgical Procedure Peribulbar anesthesia
Remove pterygium
Tenon's layer was extensively removed to superior
and inferior recti and back to the caruncle
Bare sclera: 14×14 mm with medial rectus remained
Mitomycin C (0.2mg/ml) for 2 minutes
Amniotic membrane transplantation with fibrin glue
3 ×10-0 nylon sutures to anchored AM and limbus
2 × 8-0 vicryl sutures to anchor conjunctival edge and
the edge of the AM at 3 mm away from the limbus

7. Observational Parameters

8. Grading Systems for Recurrence and Cosmetic Results

9. Grading of Postoperative Wound Edge and Caruncular Morphology
(A) Normal wound edge at temporal canthus (Grade 1) (B) Grade 1 : Nasal (C) Grade 2 : Nasal (D) Grade 3 : Nasal (E) Grade 4 : Nasal (F) Grade 5 : Nasal

10. Additional Complications
(A) Granulom pyogenica in a grade 4 caruncle; (B) subamniotic membrane hemorrhage; (C) fat prolapse at the caruncle ; (D) synechia of the caruncluar area with limitation of ocular motility limitation

11. Biographic Data 57 patients undergoing P.E.R.F.A.M.T. in 58 eyes.
40 primary/18 recurrent pterygium
All patients received follow-up for at least 12 months.

12. Results Post-Operative Recurrence
Grade 1: 47 (47/58=81%)
Grade 2: 0
Grade 3: 7 (7/58=13.8%)
Grade 4 (true corneal recurrence): 4 (4/58=6.9%)

13. Nasal Conjunctival Edge and Caruncular Morphology
Grade 1: 32/54=59.3%
Grade 2: 8/54=14.7%
Grade 3: 5/54=9.3%
Grade 4: 9/54=16.7%
Grade 5: 1/54=1.9%

14. Additional Complications
Granuloma Pyogenica: 3/58 (5.1%)
Transient diplopia: 2/58 (3.3%)
Permanent motility restriction: 2/58 (3.3%)
Steroid induced glaucoma: 2/58 (3.3%)
Fat prolapse: 1/58 (1.7%)
Submembrane hematoma: 1/58 (1.7%)
Calcium deposition: 2/58 (3.3%)

15. Conclusions
P.E.R.F.A.M.T. results in low recurrence rate, satisfactory cosmetic results of conjunctival wound edge/caruncle, and low additional complications
P.E.R.F.A.M.T. is easy to performed, and can save operative time
P.E.R.F.A.M.T. can avoid the significant conjunctival damage compared to conjunctival transplantation (P.E.R.F.E.C.T)

16. The End