title: Large pterygium surgery: When coverage of the scleral bed justifies graft rotation.
abstract: OBJECTIVE
  To perform a 12 month follow-up study to assess the safety and effectiveness of resection and conjunctival autograft fixed with Tissucol® in selected cases of large pterygium. The orientation of the graft was adapted to the morphology of the scleral bed for a better coverage free of traction, with limbal position being lost.
  
  
  METHODS
  A prospective, non-comparative study of 10 cases of grade II or superior pterygium (7 primary, 3 recurrent) with at least 8mm of limbal extension. A wide scleral bed was obtained after pterygium and Tenon resection, with larger grafts being required to cover the defects. A superior conjunctival autograft was harvested and fixed to bare sclera using Tissucol. The orientation was adapted to the morphology of the scleral bed and limbal position was lost. Patients were periodically assessed for recurrence and complications for a period of 12 months.
  
  
  RESULTS
  Minor complications occurred in 4 eyes. In one case a buttonhole was formed during dissection of the graft. Two presented with small limbal dehiscence, but epithelialisation was completed in the first week. In a third case, it was necessary to increase topical corticosteroids for pyogenic granuloma on the donor site, with secondary increased intraocular pressure (IOP). There were no recurrences after 12 months follow-up.
  
  
  CONCLUSIONS
  A conjunctival graft of appropriate size adapted to the morphology of the scleral bed to ensure good coverage free of tension, provides good surgical results in selected cases of pterygium, regardless of the conservation the limbal orientation, with no recurrences after one year follow-up.
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España. Electronic address: agargallobenedicto@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Gargallo-Benedicto
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: D
authors.initials: D
authors.lastname: Hernández Pérez
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Á
authors.initials: Á
authors.lastname: Olate-Pérez
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Betancur-Delgado
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: Cerdà-Ibáñez
authors.affiliation: Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: A
authors.initials: A
authors.lastname: Duch-Samper
mesh_terms: D000368:Aged; D003228:Conjunctiva / Q000637:transplantation*; D005260:Female; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D011625:Pterygium / Q000473:pathology / Q000601:surgery*; D012399:Rotation; D012590:Sclera / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Autoinjerto conjuntival; Cirugía de pterigión; Conjunctival autograft; Células madre limbares; Limbal stem cells; Pterygium recurrence; Pterygium surgery; Recurrencia del pterigión