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LIMBAL CONJUNCTIVAL AUTOGRAFT TRANSPLANTATION
AFTER EXTENSIVE REMOVAL OF PRIMARY AND
RECURRENT PTERYGIUM USE OF BIOLOGICAL GLUE
Joaquim Murta, MD PhD, Maria J Quadrado, MD,
Teresa Torrent MD, Pedro Fonseca MD and Sérgio
Leal MD Biomedical Institute Light and Image
(IBILI), Dep Ophthalmology-University Hospital
Coimbra, Coimbra, Portugal
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PURPOSE
Pterygium is an active, invasive and inflammatory
process, a key feature of which is focal limbal
failure. An ideal pterygium surgery should have
a low recurrence rate, lack of complications and
a satisfactory cosmetic appearance. A variety of
surgical procedures have been described for the
treatment of pterygium however, recurrence
remains a significant problem. The purpose of
this work was to evaluate the safety and
efficacy of limbal conjunctival autograft
transplantation with and without (biological
glue Tissucol) sutures for treating advanced
and recurrent pterygium.
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PTERYGIUM
Type I well-defined body and a head less
than 2 mm onto the cornea Type II (primary and
recurrent) invades the cornea 2 4 mm
causes significant astigmatism and mild
reduction BCVA Type III (very advanced
primary and severe recurrent) invades the
cornea more 4 mm and causes significant
reduction VA
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Pterygium Pathogenesis
UV - ß radiation - ophthalmohelioses Growing
from limbal epithelium A segment of limbal
epithelium, the migrating limbus, invades the
cornea centripetally A distinct type of
corneal cells develops at the leading edge
Vascularization occurs in the conjunctiva
Bowmans layer is dissolved under edge of the
pterygium A high recurrence rate Dushku,
2001
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Ideal Treatment

• Low recurrence rate
• Lack complications
• Satisfactory appearance

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SURGICAL TECHNIQUE
Pterigium head undermined and removed by
blunt dissection Pterigium body removed
Extensive removal subconjuntival
fibrovascular tissue (fibroblasts from
pterigial head overexpress MMP I and III)
Limbal-Conjuntival Autograft Transplantation (use
of suture or biological glue-Tissucol)
Contact lens (CL) Topical steroids (4-7 weeks)
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MATERIAL
79 eyes Group I 50 primary (16 Tissucol was
applied) Group II 29 recurrent Sex 46 M
30 F Age (mean) 46 years (24 - 64)
Follow-up (mean) 22 months (from 6 m to 5 y)
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FINAL OUTCOME GRADING
Grade 1 normal appearance of operated
site Grade 2 presence fine episcleral vessels
in excised area, extending to the limbus, but
without any fibrous tissue Grade 3
fibrovascular tissue in excised area, reaching
to the limbus but not invading the
cornea Grade 4 true corneal recurrence, with
fibrovascular tissue invading the cornea
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TISSUCOL KIT (Baxter)
Tissucol (clottable protein) - fibrinogen -
plasmafibronectin - Factor XIII -
plasminogen Aprotinin sol Thrombin (4UI/ml)
Thrombin (500 UI/ml) Calcium chloride solution
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2 cases of pterygium surgery (pre and post-op)
after using biological glue - Tissucol
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RESULTS
62 eyes had a rapid anatomical and functional
recovery with excellent cosmetic results. Visual
acuity increased in 7 eyes and remained
unchanged in 72 eyes. In 6 cases (7.6 ) 1
from group I (2.0 ) and 5 from group II
(17.2) - we observed a grade 4 of recurrence.
One case with Tissucol an additional suture was
necessary 2 days after the procedure.
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CONCLUSION
Limbal conjunctival autograft transplantation
with removal of subconjunctival fibrovascular
tissue is an effective and safe procedure for
pterygium surgery with a very low recurrence
rate for both advanced primary and recurrent
pterygium. The use of Tissucol allows a more
rapid surgery and much less post-op discomfort
for the patient.