A Simplified Treatment Algorithm for the Management of Primary Double-headed Pterygium

Abstract

Aim: To study different methods in the management of primary double-headed pterygium and to propose a simplified treatment algorithm for its surgical management. Methods: A retrospective study was performed on 335 eyes. All the surgeries were carried out under subconjunctival infiltrative anaesthesia. In Group I, patients underwent excision of pterygium with a horizontal conjunctival autograft (CAG). Patients in Group II underwent a vertical split CAG with limbal orientation, while in Group III, limbal orientation was not maintained. In Group IV, patients underwent conjunctival tissue graft from pterygium and conjunctival autografting. Results: Recurrence was observed in five of the 96 eyes in Group I (5.2%) and among 12 of the 99 eyes in Group II (4.04%). Recurrence was observed in three out of 87 eyes (3.45%) in Group III, and four out of 53 eyes (7.5%) in Group IV. All four groups had low and comparable recurrence rates. The follow-up period for all patients was extended for a minimum of 6 months, with mean follow-up durations of 16.79 months in Group I, 18.30 months in Group II, 17.28 months in Group III and 14 months in Group IV. Conclusion: Outcomes of horizontal and vertical split conjunctival autografting with/without limbal orientation and conjunctival tissue from pterygium with conjunctival autografting were studied. All these methods had low and comparable rates of recurrence and are therefore effective in the surgical treatment of double-headed pterygium.

Keywords

• conjunctival autograft
• primary double-headed pterygium
• recurrence rate
• split conjunctival autograft