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as noted by Cameron, the aim of using irradiation in the management of pterygium was to destroy episcleral vessels that could potentially provide nutrition for a recurrent pterygium. It should be noted that the doses of -radiation used in the treatment of patients described herein were not excessive. It has been shown that following limbal conjunctival autografting, the graft may be perfused from the underlying episcleral vascular bed as early as 1 week postoperatively. It is almost certain that this vascular bed is deficient after irradiation and, therefore, graft failure in this setting should come as no surprise. Interestingly, Cameron described a case of partial sloughing of a mucous membrane graft over an area of avascular sclera resulting from previous -radiation treatment applied at the time of pterygium surgery. Furthermore, there may be similarities between irradiation and antimetabolites such as mitomycin in their action on conjunctival and episcleral vasculature. Mitomycin is cytotoxic to vascular endothelial cells in vitro, and clinically there may be loss of vascularity after application of mitomycin in glaucoma filtering surgery. None of the patients described here showed any clinical signs of underlying scleral inflammation or necrosis. Therefore, this appears to be a separate entity from surgically induced necrotizing scleritis, a condition that may also cause conjunctival autograft failure after pterygium surgery. In deciding on the optimal surgical management for pterygium, use of adjunctive destructive techniques should be carefully considered. In addition to the risk of sightthreatening complications such as scleral necrosis and infective scleritis, it appears that these techniques also interfere with future surgical management in cases of recurrence, as described here. Reconstructive surgery using a limbal conjunctival autograft can provide excellent results for both primary and recurrent pterygia; however, the procedure is time consuming and there is considerable variation in technique among surgeons. In the setting of previous irradiation or mitomycin therapy, there may be a role for preoperative assessment of anterior segment circulation with indocyanine green angiography before considering autograft surgery. Because use of amniotic membrane grafts appears to delay vascularization as compared with a conjunctival autograft, this method should also be reconsidered in the surgery of recurrent pterygia. These considerations reduce surgical options for treating recurrent pterygium, and we believe that methods to improve graft survival after pterygium surgery in this setting should be considered.

archives of ophthalmology

Correlation of Lines of Increased Autofluorescence in Macular Dystrophy and Pigmented Paravenous Retinochoroidal Atrophy by Optical Coherence Tomography