A DOUBLE HEADED PTERYGIUM EXCISION WITH CONJUCTIVO-LIMBAL AUTOGRAFT WITH DRY AMNIOTIC MEMBRANE GRAFT AS AN ADJUVANT THERAPY - A CASE STUDY

Dr. Nisar Ali Khan, Dr. Pournima Shyamrao Sawale, *Dr. Swetha Laxminarayana Vemula

ABSTRACT

Pterygium is a common ocular surface disorder characterized by fibrovascular growth onto the cornea. Surgical excision remains the primary treatment, but recurrence continues to be a significant challenge. Conjunctival Limbal Autograft (CLAG) and Amniotic Membrane Graft (AMG) are widely used techniques aimed at reducing recurrence. A single case study was carried out in GAC, Nanded to promote healing and reduce recurrence in case of double headed pterygium where limited amount of autologus tissue was available. Limbal conjunctival autografting involves transplantation of limbal stem cells in addition to autologus conjunctiva.[1] Amniotic membrane transplantation offers advantages like anti-inflammatory and anti-scarring properties promoting epithelial growth and suppressing the factors that contribute to pterygium recurrence.[2] This study shows the utility of AMG in promoting proper healing and reducing the risk of complications such as sclerocorneal thinning and incidence of post-operative corneal perforation due to improper healing. The patient underwent pterygium excision with meticulous Tenon’s dissection, followed by placement of a superior CLAG(nasally) to restore the limbal barrier and AMG(over cornea and temporal bare sclera) to enhance epithelial healing. Sutures were used for graft fixation. Postoperatively, the patient demonstrated rapid epithelialization with minimal inflammation. The grafts remained well-positioned, and symptoms resolved within the first post-operative week. No recurrence or complications such as graft oedema, granuloma, or symblepharon were observed. The cosmetic outcome was excellent. This case illustrates that combining CLAG with AMG following pterygium excision can provide effective ocular surface restoration, rapid healing, and excellent cosmetic appearance with no early recurrence. This technique may be particularly beneficial for patients with large, double headed pterygium or at higher risk of recurrence or with significant tissue non-availability.

Keywords: Amniotic membrane graft, Conjunctivo-limbal autograft, Double headed Pterygium Surgery, Recurrence.