Healing of autologous conjunctival grafts in pterygium surgery

To temporally study the healing of conjunctival autografts in consecutive patients following pterygium surgery.

A case-cohort observational study. Thirty-two eyes of 28 patients who underwent pterygium surgery were included. All eyes had pterygium excision with conjunctival autografts. Twenty-seven eyes of 24 patients underwent excision of primary pterygium while five eyes of four patients had surgery for recurrent pterygium. All grafts were attached using fibrin glue. Mitomycin-C 0.04% was used intraoperatively in 25 eyes. All eyes were followed up at 1, 2, 4, 8, 12 weeks and 6 months postoperatively. Photographs were taken at each visit to monitor graft vessels, re-perfusion and healing. Main outcome measures were graft loss; re-perfusion of grafts and appearance and resolution of oedema, transudation and haemorrhage; approximation of graft edges to host bed and changes at donor site.

No graft tissue was lost. In all eyes, healing of autografts started with graft swelling due to oedema and transudation followed by re-perfusion injury, which manifested as swelling, variable vessels calibre, patchy or diffuse haemorrhage occurring within first week and resolving by fourth postoperative week. Graft vessels anastomose with vessels in surrounding conjunctiva and underlying episclera to re-establish blood circulation. Retraction of graft edges from surrounding conjunctiva was uncommon with rapid epithelialization of exposed (epi)sclera.

Conjunctival autografts in pterygium surgery follow a consistent healing pattern dominated by re-perfusion injury in early postoperative days. This produces dramatic changes in the autograft for which patients should be counselled before surgery. Conjunctival autografts are not at risk of falling off, losing epithelial cover or undergoing necrosis.