In this study, we used the fibrin sealant (Tisseel) to attach conjunctival grafts to the sclera and close the conjunctiva at the donor area.
We think a prospective head-to-head comparison between horizontal and vertical split conjunctival grafts in treating primary double-headed pterygia would be beneficial in deciding which technique is superior.
** The size of conjunctival grafts equal to the size of conjunctival defects.
A free conjunctival graft of the same size of both nasal and temporal conjunctival defects was obtained from the superior bulbar conjunctiva.
In our study, we adopted vertical SCG technique maintaining the limbus-limbus orientation of the graft which gives an advantage of including the limbal tissue in the conjunctival graft for both nasal and temporal sides, restoring the barrier effect of the limbus.
Recurrence rates following bare sclera resection range from 24% to 89%, 4-5 following bare sclera resection with mitomycin application between 0% and 38%, (3-6,7) and following pterygium resection with conjunctival graft placement between 2% and 39%.
The conjunctival graft was then placed on the scleral bed, with epithelial side up without losing the limbal orientation [figure 8] and the whole graft was compressed gently into position with lens spatula for 5 to 6 minutes to counter any small hemorrhage or fluid accumulation beneath the graft [figure 9] then after stabilization [figure 10] antibiotic-steroid ointment was inserted into the conjunctival sac and the eye was bandaged for 24 hours.
Accordingly, inclusion of limbal epithelium in the conjunctival graft for pterygium surgery would achieve better anatomic and functional reconstruction after pterygium removal and, by restoring barrier function of the limbus, could reduce recurrence.
The conjunctival graft was dissected from the superotemporal bulbar conjunctiva.