Sealing the gap with amniotic membrane transplantation for primary and recurrent pterygium

Abstract

Pterygium is characterized by encroachment of an abnormal fibrovascular tissue from the bulbar conjunctiva onto the cornea (Arch Ophthalmol 115:1235- 1240, 1997). Upon reaching the corneal surface, this fibrovascular tissue exerts cicatricial traction that flattens the caruncle and obliterates the semilunar fold (Arch Ophthalmol 130:39-49, 2012). The indications for pterygium surgery include reduced vision due to obscuration of the optical center of cornea, irregular astigmatism, chronic irritation, recurrent inflammation, motility restriction, and cosmetic reasons. Numerous surgical techniques have been described, but the main concern of pterygium surgery is the unpredictable rate and timing of recurrence (Ocul Surf 12:112-119, 2014). After pterygium excision and thorough removal of the abnormal fibrovascular tissue, a gap is created between the recessed edge of the conjunctiva and underlying healthy Tenon (Arch Ophthalmol 130:39-49, 2012; Am J Ophthalmol 160:438-446, 2015). Such gap serves as the main avenue for pterygium recurrence. In this chapter, we summarize a novel surgical technique termed as "sealing the gap" combined with amniotic membrane transplantation to restore the caruncle morphology, create a mechanical barrier against the truncated fibrovascular tissue, and prevent recurrence without the use of mitomycin-C. The same procedure can be used for both primary and recurrent pterygium (Arch Ophthalmol 130:39-49, 2012).