Split thickness buccal mucous membrane grafts and beta irradiation in the treatment of recurrent pterygium

Abstract

Background: Pterygium is a common problem and after surgical removal may recur in up to 80% of cases, depending on the technique of primary excision. Recurrent pterygia can be aggressive and repeated excision may result in severe conjunctival scarring and shortening, resulting in insufficient conjunctiva to perform further grafting and lid surgery. When there is insufficient autologous conjunctiva, mucous membrane must be obtained from other sites. Full thickness buccal mucous membrane grafts have been described, but they may result in a beefy red appearance, with graft contraction and a poor tear film.

Method: The use of split thickness buccal mucous membrane grafts is described in three patients with recurrent pterygium, two in combination with lamellar keratoplasty. beta Irradiation was used as adjuvant therapy in all cases.

Results: In all three cases an acceptable cosmetic appearance was achieved, with no recurrence of the pterygium, and a good range of eye movements.

Conclusions: It is recommended that split thickness buccal mucosal grafts, combined with beta irradiation, should be considered in complex cases of pterygium recurrence when there is insufficient autologous conjunctiva and conjunctival shortening with restricted eye movements.

Figure 1

Case 1, before surgery, showing the extensive recurrent temporal pterygium and symblepharon in the left eye.

Figure 2

Case 1, after surgery to the left eye, showing the lamellar keratoplasty and buccal mucous membrane graft.

Figure 3

Case 3, before surgery, showing the recurrent pterygium and the severe symblepharon to the left lower eyelid.

Figure 4

Case 3, after left split thickness buccal mucous membrane grafting, showing the improved appearance and good range of eye movement.