Extended Tenon Removal Versus Limited Tenon Removal With Conjunctivo-Limbal Autograft in Primary Pterygium Surgery: A...

Background Pterygium is a common fibrovascular conjunctival disorder that may cause astigmatism, visual impairment, ocular discomfort, and cosmetic concerns. Surgical excision remains the definitive treatment; however, recurrence continues to be a major challenge. Conjunctivo-limbal autograft transplantation has been widely adopted to reduce recurrence, yet the role of Tenon's layer excision in improving surgical outcomes remains insufficiently explored. This study was undertaken to compare the outcomes of conjunctivo-limbal autograft transplantation performed with extended Tenon removal versus limited Tenon removal in primary pterygium surgery. Methods This prospective comparative study was conducted in the Department of Ophthalmology at a tertiary care center and included 60 patients with Grade 2 or Grade 3 primary nasal pterygium. Patients were alternately allocated into two groups of 30 each. Group A underwent pterygium excision with extended conjunctival and Tenon removal followed by autologous serum-assisted conjunctivo-limbal autograft transplantation, while Group B underwent excision with limited Tenon removal followed by the same grafting technique. Preoperative evaluation included slit-lamp examination, keratometry, and assessment of uncorrected and best-corrected visual acuity. All surgeries were performed by a single surgeon under peribulbar anesthesia. Postoperative follow-up was done at 24 hours, one week, one month, three months, and six months. Outcomes assessed included astigmatism, visual acuity, postoperative complications, and recurrence. Statistical analysis was performed using IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 27. Armonk, NY: IBM Corp. Results The mean age of the study population was 53.45 ± 8.42 years, with males constituting 43 of 60 patients (71.7%). Grade 2 pterygium was the most common presentation, observed in 59 patients (98.3%). Mean corneal astigmatism significantly reduced from 2.02 ± 1.10 diopters preoperatively to 0.81 ± 0.54 diopters at six months postoperatively (p < 0.05). Early postoperative complications included mild subconjunctival hemorrhage in 45 of 60 patients (75.0%) and graft edema in 9 of 60 patients (15.0%), with no significant difference between the two groups. At six-month follow-up, recurrence was noted in 1 of 30 patients (3.3%) in the extended Tenon removal group and in 4 of 30 patients (13.3%) in the limited Tenon removal group; however, this difference was not statistically significant (p = 0.161). Conclusion Conjunctivo-limbal autograft transplantation combined with extended Tenon removal demonstrated a lower recurrence rate and fewer graft-related complications compared to limited Tenon removal, although the difference was not statistically significant. Both surgical approaches resulted in significant improvement in astigmatism and visual acuity. The findings highlight the contributory role of Tenon's layer in pterygium recurrence and support a comprehensive surgical approach for optimal outcomes. Further studies with larger sample sizes are warranted to substantiate these observations.