Grading system improves surgical outcomes of multicurrent pterygia

Residual conjunctiva measurements and caruncle morphological characteristics help grade recurrent pterygium severity, assist in surgical techniques and predict the surgical outcomes, claims a study in the journal Archives of Ophthalmology.

The investigation, led by Dr Jingbo Liu, Ocular Surface Centre, Miami, Florida, USA, consisted of 32 eyes of 30 pterygia patients. All participants were managed at the Ocular Surface Centre between January 1 2002 and December 21 2010.

Eyes were successively operated on by recession, sealing of the gap, covering of exposed medial rectus muscle by amniotic membrane, conjunctival autograft or oral mucosal graft (OMG) and the covering of the bare sclera with amniotic membrane. The main outcome measures were recurrence, diplopia and caruncle morphological characteristics.

The findings demonstrated a strong correlation between caruncle grading and residual conjunctiva, severity of diplopia and overall success rate. In 23 eyes with residual conjunctiva of 27.8 mm the amniotic membrane transplantation was enough.

The residual conjunctiva was significantly longer in the six patients who underwent failed amniotic membrane transplantation. A further eight patients experienced successful transplantation, but required additional conjunctival autografts or oral mucosal grafts.

Total success was seen in 30 of 32 eyes and 17 of 21 eyes didn't experience recurrence, diplopia and normal caruncle. Only one eye presented with a depressed caruncle and residual diplopia.

The study revealed that sealing the gap is essential for creating a strong barrier to prevent recurrence, to restore caruncle morphological characteristics and regain complete motility in multirecurrent pterygia.