59
EW CORNEA
The conjunctival autograft is cut free from the superior limbus.
Thrombin diluted with balanced salt solution is placed on the excision site, and fibrinogen is
placed on the stromal side of the autograft.
The conjunctival autograft is inverted, mixing the adhesive components, and smoothed to
approximate the edges of conjunctiva.
Source (all): John Hovanesian, MD
July 2017
The pterygium has been excised and the autograft prepared and reflected onto the cornea at
the superior limbus.
continued on page 60
or if it has been done twice else-
where. In such cases he uses a com-
bination of conjunctival autografts,
MMC (at the edge of the conjunc-
tiva, for a minute, then washes it
thoroughly), amniotic membrane,
and a mini-SLET—which has fewer
explants.
Dr. Sangwan uses amniotic mem-
brane for all pterygium cases but not
for the prevention of recurrence.
"It's more for improving the
healing, reducing the scarring, and
reducing the pain to the patient
postop," Dr. Sangwan said. "I don't
think it is possible to prevent recur-
rence with amniotic membrane."
Surgical pearls
Dr. Slomovic highlighted that
conjunctival autograft has been
shown to reduce the incidence of
recurrence. Additionally, judicious
use of MMC is beneficial where
there is suspicion of increased risk of
recurrence.
For Dr. Sangwan, the most
important part of excision is the
dissection.
"You should remove all of the
abnormal tissue, put a conjunctival
autograft on, do a mini-SLET, and
