Pentagonal vs quadrangular conjunctival autograft in pterygium surgery: a comparative study on graft retraction

To investigate the effect of pentagonal conjunctival autograft on reducing graft retraction following pterygium surgery.

This retrospective comparative study included patients who underwent primary pterygium excision with either pentagonal (created by shaping the junction with the recipient conjunctiva into a wedge) or quadrangular conjunctival autograft transplantation. All patients completed a 6mo postoperative follow-up. The primary outcome measure was the incidence of graft retraction; secondary outcomes included graft displacement requiring re-suturing and pterygium recurrence rate.

The study enrolled 58 participants, comprising 26 (15 males, 11 females) in the pentagonal graft group (mean age: 54.9±13.1y), and 32 (17 males, 15 females) in the quadrangular graft group (mean age: 57.6±10.4y). Graft retraction occurred in only 1 eye (3.8%) in the pentagonal autograft group, compared to 9 eyes (28.1%) in the quadrangular autograft group. No cases of graft displacement requiring re-suturing were reported in the pentagonal autograft group. Although graft displacement and recurrence requiring re-suturing were observed less frequently in surgeries with a pentagonal graft, the difference was not statistically significant (P>0.05).

Designing the conjunctival autograft in a pentagonal shape-mimicking geodesic dome architecture and conforming to the eye's spherical structure-enhances compatibility with the recipient conjunctiva and improves resistance to physical traction forces. This design effectively reduces the incidence of graft retraction and other related complications, providing a more favorable surgical option for pterygium treatment.