To report a technique to prevent pterygium recurrence using the principle of contact inhibition.
Two hundred and fifteen patients (232 eyes; average age, 64.1 years) with primary pterygia who underwent pterygium surgery at the Hara Eye Hospital between 1999 and 2012. We retrospectively evaluated the patients who underwent the following procedure to prevent pterygium recurrence. The surface conjunctiva on the pterygium body was not removed. After removing the pterygium body, by placing a narrow pedicle autoconjunctival flap along the corneal limbus and tying it tightly to the front area of the residual conjunctiva, there is no room for the active residual tissue to proliferate, thus preventing a recurrence by contact inhibition. The key factor is conjunctival suturing, which establishes face-to-face contact of both areas of cut conjunctival tissue. Mitomycin C is applied locally for 3 min intraoperatively and 5 days postoperatively. The main outcome measure was the prevention of pterygium recurrence using this technique.
By the end of the average follow-up of 5 years 4 months, three eyes (1.3%) had a recurrence. Among the 232 eyes, 23 eyes had large pterygia extending to the pupillary area. Using the surgical technique, there were no recurrences. No specific characteristic of the recurrence was found in association with the eye, sex, and preoperative grade.
This surgery has three relevant features: (1) reconfirmation of the effect of contact inhibition, (2) the anatomic structure of the conjunctival sac scarcely changes postoperatively, because the surface conjunctiva of the pterygium body is not removed, and (3) a low recurrence rate.
An edited 2-minute video of actual surgery. Saved at four times fast play. (MP4 10371 kb)
Hara T, Shoji E, Hara T, Obara Y (1994) Pterygium surgery using the principle of contact inhibition and a limbal transplanted pedicle conjunctival strip. Ophthalmic Surg 25:95–98 PubMed
Mourits MP, Wyrdeman HK, Jurgenliemk-Schulz IM, Bidlot E (2008) Favorable long-term results of primary pterygium removal by bare sclera extirpation followed by a single 90Strontium application. Eur J Ophthalmol 18:327–331 PubMed
Prabhamsawat P, Barton K, Burkett G, Tseng SCG (1997) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 104:974–985 CrossRef
Shimazaki J, Yang HY, Tsubota K (1996) Limbal autograft transplantation for recurrent and advanced pterygia. Ophthalmic Surg Lasers 27:917–923 PubMed
Masuda A, Takahashi K, Minami K, Miyata K (2013) Pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C for pterygium: a retrospective assessment of 1932 eyes. J Jpn Ophthalmol Soc 117:743–748
Mahdy MA, Bhatia J (2009) Treatment of primary pterygium: role of limbal stem cells and conjunctival autograft transplantation. Eur J Ophthalmol 19:729–732
Hara T, Hara T (1983) Simple pterygium surgery with an electric drill and mitomycin-C eye drops. Afro-Asian J Ophthalmol 1:160–163
- Pterygium surgery using the principle of contact inhibition: results of 13 years’ experience
- Springer Berlin Heidelberg
- Graefe's Archive for Clinical and Experimental Ophthalmology
Incorporating German Journal of Ophthalmology
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X