STUDY ON EFFICACY OF CONJUNCTIVAL AUTOGRAFT SURGERY WITH LIMBAL STEM CELLS IN ADVANCED, RECURRENT PTERYGIUM

BACKGROUND Pterygium is epithelial hyperplasia and elastotic degeneration of the bulbar conjunctival tissue encroaching over the cornea. Healthy limbus acts as a barrier to conjunctival overgrowth and recurrence of pterygium. Surgery is the mainstay of treatment for all types of pterygium. Despite the numerous techniques available, recurrence after surgery for pterygium presents a significant problem. Considering the importance of the limbus and its stem cells in the pathogenesis of the pterygium, a new technique has been developed that includes, in addition to the conjunctival autograft, a part of the limbal stem cells that aids in the complete anatomic and physiologic reconstruction of the excised pterygium area. This limbal reconstruction may theoretically reduce the recurrence rate. MATERIALS AND METHODS A prospective observational study was conducted among 40 patients with advanced, recurrent pterygium. Only those who fulfil the inclusion and exclusion criteria were taken up for the study. After thorough pre-operative evaluation, conjunctival autograft surgery with limbal stem cells was performed in all cases of advanced, recurrent pterygium by a single surgeon. The postoperative observations were made in terms of graft oedema, graft retraction, graft necrosis, conjunctival granuloma and corneoscleral dellen. Besides above, care was taken to look for any defects in graft postoperatively by careful examination after fluorescein staining under slit lamp. The presence of any remnant fibrous tissue after excision of pterygium, proper positioning, and opposition of graft edges was also checked postoperatively. Long-term recurrence of pterygium and the best corrected visual acuity were also determined.