MAR 2020

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/1215009

Contents of this Issue


Page 82 of 118

80 | EYEWORLD | MARCH 2020 C PRESENTATION SPOTLIGHT ORNEA by Stefanie Petrou Binder, MD Contributing Writer A novel treatment method for recur- rent pterygium using a simple limbal epithelial transplantation (SLET) technique was presented by Tanya Trinh, MBBS. She described a case series that demonstrated SLET as not only a viable surgical option, but one that targets one of the key pathological processes in the development of pterygium. This case series is the first to present SLET as a treatment option for surface reconstruction of recurrent pterygium. "Limbal stem cell disease has been pro- posed as one of the inciting events in pterygium formation," Dr. Trinh said. "SLET permits the harvesting of less limbal stem cell tissue for oc- ular surface reconstruction, which may reduce the risk of iatrogenic stem cell disease. In this case series it has also permitted surgery to be restricted to the affected eye only, preserving the integrity of the other eye." Background Pterygia are fibrovascular growths extend- ing from the conjunctiva onto the cornea. Recurrence rates after primary pterygium surgery varies widely in the literature but can be as high as 30–88%. 1 None of the various treatment methods preclude recurrences, however, some of the more popular techniques involve repeat con- junctival autografting, the use of amnion, and mitomycin-C application with relative- ly good efficacy. 2,3 According to the literature, SLET was first described in 2012 for treating unilater- al limbal stem cell disease. 4 Healthy limbal stem cells are harvested from the unaffect- ed eye or from the ipsilateral affected eye and transplanted onto the diseased corneal surface. Other studies document SLET for unilateral chemical burns, ocular surface squamous neoplasia, and primary pterygi- um excision. 4–7 Surgical method The SLET procedures in this case series were performed by the same surgeon. A crescent blade was used to isolate a healthy limbal strip of approximately 4 mm x 2 mm. The limbal tissue was then cut into about 10 pieces with Vannas scissors and stored in balanced salt solution. The pterygium was excised in standard fashion with the aid of a 64-Beaver blade, Westcott scissors, and forceps. A 360-degree conjunctival peritomy was performed to expose the limbal sclera. Mitomycin-C 0.02% was ap- plied for 2–3 minutes subconjunctivally, and the ocular surface was debrided of residual scarified tissue. Case series of novel recurrent pterygium treatment method Top: This is a double-headed kissing pterygium in a patient with prior pterygium surgery 6 years earlier. Bottom: At 12 months postop, the cornea was clear with no signs of recurrence in this aggressive case. Source: Tanya Trinh, MBBS About the doctor Tanya Trinh, MBBS University Health Network Donald K. Johnson Eye Institute Toronto, Canada Contact Trinh: Tanya.Trinh@gmail.com continued on page 82

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - MAR 2020