Pterygium Excision with Conjunctival Autograft

John Hofbauer, MD, and Nicole Fram, MD, present a case of pterygium excision in a 38-year old Hispanic male using conjunctival autograft, fibrin glue, mitomycin 0.03% and anchoring sutures. This video demonstrates the importance of careful dissection to the “root” of the pterygium rather than simply excising the pterygium flush to the plica. Subconjunctival dissection under the plica and generous tenonectomy are necessary to prevent recurrence. Four anchoring interrupted 10-0 nylon sutures are used to prevent slippage or gap of the conjunctival autograft that may occur with fibrin glue alone. Pearl: Place conjunctival autograft 1mm posterior to the limbus to avoid corneal opacity post-operatively.

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Comments (3)

Is there any risk of lesion of the muscle by going so far in tenonectomy?

Cintia (45 months ago)

Great technique. I operate mostly in an outpatient surgery center and have had difficulty with reimbursement for the glue. Any suggestions for increasing chances for reimbursement?

HLemley (49 months ago)

i like the technique of anchoring at limbus and then rolling graft backwards after glue. i disagree re: going after the pterygium all the way to the plica. i dont think it is the cause of recurrence, and you can get some nice bleeding back there. i think a well-placed graft, some modest removal of tenon's, and nice cleanup at the limbus is what reduces recurrences.

ranchump62 (50 months ago)