1、Pterygium Surgery with Sutured Conjunctival Autografts,David S. Rootman, MD, FRCSC Associate Professor, University of Toronto,Why Sutures When We Can Glue?,More secure fixation of autograft Less likely to dislocate Stretches out a smaller autograft Long track record No bovine or foreign blood produc
2、ts Less messy Good suturing practice Less expensive,Disadvantages of Sutures,Takes longer More difficult Sutures irritate patient More likelihood of bleeding May have to remove sutures,Seven Principles of Procedure,Smooth partial keratectomy Release of Tenons capsule constriction Thin autograft Alig
3、nment of graft Secure suturing of graft Bandage contact lens,Keratectomy,As described by Richard Abbott 7-0 Silk fixation suture Inject under pterygium with 1% xylo with epi Angled cut at anterior edge of pterygium Smooth dissection in anterior stroma Removal of all scar tissue on cornea Similar to
4、making a phaco scleral tunnel,Keratectomy,Release of Tenons Capsule,Do not over dissect Release medial rectus on both sides Allow conjuctiva to slide back to caruncle Mark extent of excision Minimal removal of conjunctiva Stay away from caruncle,Autograft harvesting,Measure area of resection Pull ey
5、e downward Use Gentian violet to mark area Central mark to help orientation Rhomboidal shape, wider at posterior edge Make graft as thin as possible,Meaure autograft,Alignment of Graft,Slide conjunctiva on cornea, Tenon up Appose limbal cells to limbus at site of excision Secure with 10-0 monofilame
6、nt vicryl Turn graft over after secured at limbus,Suturing of Autograft,Secure in all four corners with scleral bite Avoid medial rectus to minimize bleeding Close nasal conjuntiva to conjunctiva of graft, no scleral bite here Close edge to edge superiorly and inferiorly No exposed Tenon capsule, pr
7、events granuloma Do not advise running suture,Bandage Contact lens,Apply at end of procedure More comfort for patient No patch needed Leave on for 2 weeks Lessens chance of Dellen Steroids for 6 weeks qid or until eye white,Complications,Recurrence Inflammation Melting (more common with Mito C) Infection Bleeding Dellen Granuloma,Recurrence,Inflammation,Necrosis,Infection,Dellen,Conclusions,Pterygium excision with conjunctival flap is a good procedure with low complication rates Using sutures is a good alternative compared with tissue glue,
