The surgical management of an advanced pterygium involving the entire cornea

Conjunctival autografting is a well-established surgical procedure to prevent recurrence after pterygium excision. We described a modified technique of harvesting an annular autograft to cover a large conjunctival defect after excision of an extensive primary pterygium that involved three quadrants of the limbus.

A 73-year-old Chinese farmer underwent an excision of an advanced right pterygium involving the entire cornea. A free donor graft was then harvested from the remaining superior bulbar conjunctiva to cover the conjunctival defect, which involved approximately-three quadrants of limbus. The undersized graft was split down the center to create an annular graft to cover the defect.

Postoperatively, there has been no recurrence over a total follow-up period of 11 months. Six months after the initial pterygium surgery, he underwent a successful penetrating keratoplasty for residual deep stromal scarring. Visual acuity 5 months after the penetrating keratoplasty remained stable at 6/18.

This case report shows that a modified technique of conjunctival autografting can be successful in preventing recurrence in an advanced pterygium after excision. Successful visual rehabilitation with a penetrating keratoplasty also was demonstrated in this patient.