Shifting and sliding of medial-inferior conjunctival flap for surgical treatment of Pterygium

Purpose:To describe a novel surgery technique in the treatment of primary pterygium and to evaluate its safety and rate of recurrence. Methods:Retrospective case series. Between January 2012 and October 2013, escluded summer months, 128 patients, of which 103 were men and 25 women, all living in Sardinia (Italy) were operated on for a primary nasal pterygium. The mean age was 55,61 ± 9,93 (range 33-75). Pterygium excision was combined with a sliding and shifting congiuntival flap technique. The flap harvested from the medial inferior bulbar conjunctiva was placed over the bare sclera and glued with Tisseel (Baxter AG, Vienna), a human tissue glue. Topical and oral steroids and antibiotic eyedrops were prescribed, and the eye was patched for 1 day. Results:Patients were followed up for at least 1 year, and the outcomes and recurrence rates were evaluated. In case of fibrovascular regrowth, it was manifested by third month of follow up, but progression arrested before sixth month control. Six patients showed a corneal invasion between 1 and 2.5 mm beyond the limbus, in 1 patient the new fibrovascular tissue was 4.5 mm . The recurrence rate estimated at 1 year after surgery was 5.46%. No intraoperative complication was observed. The mean surgery time was 10.30’’ ± 1.30” minutes. Conclusions:The sliding and shifting congiuntival flap technique is a safe alternative in pterygium surgery for preventing recurrence. It is technically easier than congiuntival autograft and reduces operative time. Moreover the low rate of recurrence could be positively influenced by the reduced inflammatory reaction due to the absence of a congiuntival suture.