Pterygium: Surgical Technique

Pterygium is a common condition which many consider a relatively harmless disease and allow simple excision at the lowest level of expertise. [1,2] This results in highest rate of recurrence. There is a need to popularize a simple, low-cost, universally accessible surgical technique associated with low recurrence. Conjunctival limbal autograft (CLAU) transplantation is one such technique with low recurrence (0-4 %). [3]
Here we describe author's modification of pterygium excision and CLAU transplantation. This is a safe and effective method with no complications.[4 ]
Surgical Technique
We operate in a major operation theatre under operating microscope and use peribulbar anesthesia. We prepare skin with povidone iodine (Betadine) 5% . The

The pterygium and the Tenon’s capsule between the two radial incisions is freed from the globe by blunt dissection. 4 -5 mm away from the limbus the pterygium is cut between the two incisions. The head of the pterygium is avulsed from the cornea by the method of reverse stripping, using a pair of McPherson/ plain conjunctival forceps. It involves reversing the pterygium onto cornea and application of a slow and deliberate traction to the free end of the pterygium held parallel to the corneal surface. Once a clean plane of ' tear ( pterygium-rehxis) ' is initiated at one edge of the head, the process is led around the pterygium-head by gently rotating the tearing-edge to lift the whole of pterygium off the cornea. We include into the torn pterygium a little of the clear corneal epithelium lying beyond the pterygium cap. It is important during the process to get the correct plane of cleavage, and maintain a good grip along the whole width of the pterygium. (Figures 1 a-d). Any remnant / a tag of tissue left over the cornea is scraped off using No 15 Bard Parker knife or simply pulled off with McPherson forceps. This method

We beforehand measure the bare sclera in its radial and circumferential dimensions both at the limbus and at the canthus. The superior rectus bridle suture helps expose upper bulbar conjunctiva. A graft about 2 mm larger than the bare sclera, centered at 12 o’clock meridian on the bulbar conjunctiva is marked with Gentian violet. The conjunctiva is elevated with the subconjunctival injection of saline. A pair of conjunctival scissors is used to make two radial incisions in the conjunctiva along the marks diverging towards the upper fornix. Tenon’s capsule is avoided. Through the 2 radial incisions, about 2 mm above the limbus, we insert under the conjunctiva 2 iris repositer, one each from the opposite sides. The iris repositors railroad into each other’s track to exit through the incisions on the other side. Pulling the iris repositors apart in opposite directions, the superior fornix and the superior limbus, dissects the conjunctival graft neatly from the Tenon’s capsule. The conjunctival graft is cut at the forniceal end with a pair of sharp conjunctival scissors. It is folded down over the cornea and held stretched down with a pair of McPherson forceps. Use of a plane forceps during this step prevents buttonholing of the graft. Blunt dissection of graft downwards to the limbus and 1 mm onto the clear cornea with a Tooke’s knife or flat, blunt end of a iris repositer completes the dissection (Fig 2 a).