Donor site management in primary pterygium excision with conjunctival autograft – Less is more!

Abstract

Purpose: The aim of this study is to assess spontaneous healing of the conjunctival donor site after primary pterygium surgery and its implications. Materials and Methods: This was a prospective study of one hundred primary pterygium surgeries with superior conjunctival autografting. Ninety nasal pterygia, eight double-headed pterygia, and two temporal pterygia were included. The conjunctival epithelialization in the donor harvest site, corresponding superior limbal pigmentation, presence of any visible scarring, and mobility of the conjunctiva were documented after the surgery. The patients were reviewed on day 1, day 4, at 1 week, and 1 month after surgery, and then followed up every 4 months for a minimum of 2 years. Mean with standard deviation, percentages, and paired sample t-test were the statistical methods employed in the study. Results: Progressive pterygium with corneal involvement (87%) was the most common indication for surgery. Conjunctival epithelization was complete at the donor site within a week of surgery in all cases. At 1 month, there was no scarring or vascularization at the donor site in any of the cases. The limbus appeared intact with its pigmentation. The healed conjunctiva showed good mobility in all the cases. These were confirmed on anterior segment optical coherence tomography. There were no donor site-related complications. These findings remained stable over 2 years. Conclusion: Not closing the donor harvest area seems to allow spontaneous donor site healing in uncomplicated primary pterygium excision surgery with a superior conjunctival autograft. This avoids in-folding of unequal tissues and resultant scarring. An undisturbed Tenon's layer at the donor site acts as a scaffold for smooth conjunctival healing. The healed conjunctiva remains mobile with an intact limbus.

Keywords

• conjunctival autograft
• donor site
• pterygium