Low recurrence rate of anchored conjunctival rotation flap technique in pterygium surgery

Abstract

Background: To report the recurrence rate for an anchored conjunctival rotation flap technique in primary pterygium surgery.

Methods: Primary pterygium surgeries performed using anchored conjunctival rotation flap techniques (110 eyes in 110 patients) with a minimum follow-up of 12 months were reviewed. In this technique, a conjunctival flap is rotated to cover the bare sclera and suture-fixated with either 8-0 polyglactin (41 eyes) or 10-0 nylon (69 eyes). The recurrence rate was determined, and the two suture materials utilized were compared.

Results: The recurrence rate was 2.71% (3 cases in 110 eyes) when an anchored conjunctival rotation flap technique was used and patients were monitored for 26.40 ± 17.09 months. Interestingly, the recurrences were only observed in polyglactin-sutured eyes. No recurrence was detected in nylon-sutured eyes. No other complications were observed in either group.

Conclusions: The anchored conjunctival rotation flap technique for pterygium surgery has a relatively low recurrence rate. Nylon suture-fixation of the flap was found to be superior to polyglactin suture-fixation in preventing recurrence.

Keywords: Anchored; Flap; Nylon; Polyglactin; Pterygium; Recurrence.

Fig. 1

a & b: Primary pterygium before (a) and 48 months after (b) the anchored conjunctival rotation flap surgery in 54 year old male patient. Status of preoperative pterygium was graded as S₃V₃C₃K₃. The healing was accomplished with almost normal conjunctival appearance (grade 1). c & d: Representative pictures of the postoperative appearance of anchored conjunctival rotation flaps were shown. The conjunctival flaps were well maintained with normal vascularity. Arrows indicate the margin of the conjunctival flap. c: Forty eight months after the surgery in a 53 year old male patient (postoperative status grade 1). d: Twelve eight months after the surgery in a 68 year old male patient (postoperative status grade 1)

Fig. 2

a: Thick and fleshy primary pterygium (S₄V₃C₄K₃) is observed with destruction of plica semilunaris and caruncle distortion in 61 year old female. b and c: Twelve month after surgery, focal presence of fine episcleral vessels (red arrow) reaching to the limbus is observed with thickened conjunctival wound edge (white arrow) (postoperative status, grade 2). d: Thick and atrophic primary pterygium (S₃V₂C₃K₄) is observed with dragging of plica semilunaris in 54 year old male. e: One month after surgery, significant contraction of conjunctival flap (red arrows) was observed with advancement of fibrovascular tissue (white arrows) from nasal conjunctiva. Monthly subconjunctival injection of bevacizumab (2.5 mg in 0.1 ml) and dexamethasone (0.5 mg in 0.1 ml) into the fibrovascular tissue was carried three times. f: Twelve month after surgery, fibrovascular tissue growth (white arrows) was halted with clear conjunctiva (red arrows) (postoperative status, grade 1)