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Clinical Trials |

Limbal-Conjunctival vs Conjunctival Autograft Transplant for Recurrent Pterygia:  A Prospective Randomized Controlled Trial

Mashhoor F. Al Fayez, MD, FRCS
JAMA Ophthalmol. 2013;131(1):11-16. doi:10.1001/archophthalmol.2012.2599.
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Published online

Objective To compare the safety and efficacy of limbal-conjunctival vs conjunctival autograft transplant for treating recurrent pterygia.

Methods In a randomized, prospective, parallel-group clinical trial, 224 patients with advanced recurrent pterygia underwent free conjunctival autograft transplant (112 eyes) or limbal-conjunctival autograft transplant (112 eyes). Two hundred five patients completed the follow-up (100 eyes from the conjunctival autograft group and 105 eyes from the limbal-conjunctival autograft group).

Main Outcome Measures Recurrence of pterygium, with complications as the secondary outcome measure (ie, signs of limbal stem cell deficiency).

Results With a mean follow-up of 62 (range, 36-96) months, 10 patients (10.0%) in the conjunctival autograft group and 1 patient (1.0%) in the limbal-conjunctival autograft group developed recurrence. No signs of limbal stem cell deficiency were observed during follow-up.

Conclusion Limbal-conjunctival transplant is safe and more effective than free conjunctival transplant in preventing recurrence after excision of recurrent pterygia (P = .004).

Application to Clinical Practice Limbal-conjunctival autografts could be a favored option for managing advanced recurrent pterygia in young high-risk patients.

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Figure 1. Flow diagram for participants' progress throughout the trial.

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Figure 2. Photograph of patient 59 in the limbal-conjunctival autograft group. This patient had the only recurrence after limbal-conjunctival autografting, and the pterygium's size remained stationary at less than 1.5 mm.

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Figure 3. Photographs of patient 24 in the limbal-conjunctival autograft group. A, Right eye of the 32-year-old patient with a recurrent pterygium. B, The same eye 6 years after pterygium excision and limbal conjunctival autografting.

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