Autologous advanced tenon grafting combined with conjunctival flap in scleromalacia after pterygium excision

Abstract

Purpose. To evaluate the efficacy of autologous tenon grafting combined with conjunctival flap as a treatment for scleromalacia or scleral thinning after pterygium excision without any additional donor graft tissue. Methods. Twenty-six cases underwent autologous advanced tenon grafting combined with sliding or rotating conjunctival flap for scleromalacia after pterygium surgery ranging from 2 years to 30 years. The extent of scleral defect measured from 2.0 mm to 6.8 mm in diameter. The cosmetic outcome was defined as complete resolution of scleromalacia or completely conjunctival reepithelialization and firm adhesion between subtenon and scleral tissue over scleral thinning without significant complications. Results. All cases achieved the covering of conjunctival and tenon or subtenon tissue over scleromalacia or scleral thinning with this procedure. Preoperative pain, inflammation, and choroidal exposure disappeared after surgery. Immediate postoperative complications, such as large wound dehiscence or reopening of the scleral wound, did not occur in any of the patients. There were no significant clinical complications during the mean postoperative follow-up period of 14.17 months in all cases. Conclusions. We obtained excellent outcome with fewer complications after autologous advanced tenon graft and conjunctival flap, without an additional donor graft, in scleromalacia or scleral thinning caused by previous pterygium excision.

Figure 1

Diagram of the surgical procedure. (a) Area of scleral thinning. (b) Advanced tenon flap harvested from the superonasal site of the scleral thinning and complete covering of the scleromalacia boundary. (c) Sliding conjunctival flap was made over the area of the tenon graft with fixation sutures between conjunctiva and sclera.

Figure 2

Case 1: (a) preoperative photograph, a 2.9 × 5.3 mm sized scleral thinning with visible uvea. (b) Successful reconstruction of ocular surface at 2 months after surgery. Case 2: (c) preoperative photograph, a 3.8 × 6.3 mm sized scleral melt with visible choroid. (d) Postoperative successful reconstruction of ocular integrity at 10 months after surgery. Case 3: (e) preoperative photograph, a 4.8 × 6.8 mm sized scleral thinning with uveal exposure. (f) Successful tenon tissue graft and conjunctival flap without complications at postoperative 4 weeks. Case 4: (g) preoperative photograph, a 2.1 × 5.5 mm sized scleral thinning with large calcified plaque. (h) Successful reconstruction of ocular surface at 12 months after tenon graft combined with conjunctival flap.