Contents lists available at ScienceDirect Contact Lens and Anterior Eye journal homepage: www.elsevier.com/locate/clae Very long term success of pterygium surgery with conjunctival graft Ofira Zloto ⁎ , Nachum Rosen, Ari Leshno, Mordechai Rosner Goldschleger Eye Institute, Sackler Faculty of Medicine, Tel-Aviv University, Sheba Medical Center, Tel Hashomer, Israel ARTICLE INFO Keywords: Pterygium Conjunctival flap Surgical technique Long term prognosis ABSTRACT Purpose: To examine to the very long term prognosis (16 years in average) of pterygium surgery with superior or inferior conjunctival graft. Methods: Clinical data for patients that underwent pterygium surgery with conjunctival graft by two surgeons at the Goldschleger Eye Institute, Sheba Medical Center, Israel, between the years 1997–2001 were retrieved from medical records. For all the included patients, data about their eye examinations was summarized and a questionnaire about their eye history was done. Results: Twenty four patients were included in the study. Eleven with superior conjunctival flap (Group 1), and thirteen with inferior conjunctival graft (Group 2). In group 1, there was one surgery for recurrent pterygium, and two in group 2. In all cases the grafts were sutured and Mitomycin C was not used. No recurrence of pterygium was found in either group. No eye complications or side effects were found after sixteen years in average. Conclusions: After a very long follow-up of almost two decades there are no recurrences of pterygium or complications when using upper conjunctival flap or lower conjunctival graft during the surgery. It seems that lower graft is as good as upper flap for preventing recurrence of pterygium. Larger studies are required in order to confirm these results. 1. Introduction Pterygium, in Latin means little wing, is an abnormal fibrovascular proliferative tissue extending to the cornea in the interpalpebral area. Usually it is situated on the nasal side but sometimes it can be on the nasal and temporal side and rarely only on the temporal side. Surgical removal is the treatment of choice, and the primary challenge of pterygium surgery is the prevention of recurrence. The literature shows that bare sclera excision alone has high recurrence rates of 30–70% [1]. Therefore, in the last two decades, autologous conjunctival grafting is considered to be the best method with low recurrence rate and few side-effects [2,3]. The longest follow up time that was reported in the literature is 12 years [4]. Graft can be taken from the superior or inferior conjunctiva. Chen et al. found that there are no differences between the superior and inferior graft in recurrence rate in the first year after surgery [5]. However, to the best of the authors' knowledge, the long-term prognosis of upper versus lower conjunctival grafting was not examined in the past. The purpose of the current study is to examine the very long term results (14–18 years) of pterygium surgery using superior versus inferior conjunctival graft. 2. Methods 2.1. Patient selection and data collection Clinical data for the 60 patients that underwent pterygium surgeries with conjunctival graft by two surgeons (NR, MR) at the Goldschleger Eye Institute, Sheba Medical Center, Israel, between the years 1997–2001 were retrieved from medical records. Patients lost to follow up were excluded, as well as patients that died or could not undergo eye examination for other reasons. For all the other patients, the data about their eye examination during 2015 was retrieved and they answered a short questionnaire. The study was approved by the local institutional review board (IRB) of Sheba Medical Center. 2.2. Surgical technique After instillation of topical lidocaine (Bausch & Lomb UK Ltd., Surrey, UK), the involved eye underwent standard ophthalmologic sterile preparation and draping, after which it was exposed for surgery by means of a lid speculum. Lidocaine was injected into the pterygium head and the upper/lower conjunctiva. The pterygium was separated from the underlying sclera and surrounding conjunctiva by blunt http://dx.doi.org/10.1016/j.clae.2017.05.004 Received 3 October 2016; Received in revised form 4 May 2017; Accepted 10 May 2017 ⁎ Corresponding author at: Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Hashomer, 52621, Israel. E-mail address: ozloto@gmail.com (O. Zloto). Contact Lens and Anterior Eye xxx (xxxx) xxx–xxx 1367-0484/ © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. Please cite this article as: Zloto, O., Contact Lens and Anterior Eye (2017), http://dx.doi.org/10.1016/j.clae.2017.05.004