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Amniotic Membrane as an Antifibrotic Agent in
the Subconjunctival Space Surrounding a
Conjunctival Autograft in Pterygium Surgery
John A. Hovanesian, M.D., Andrew Behesnilian
Clinical Instructor, UCLA Jules Stein Eye Institute
Harvard Eye Associates, Laguna Hills, California
Financial Interest Disclosure:
Allergan, Abbott Medical Optics, Bausch & Lomb, Baxter
BioScience, Diopter, Inc., Essex Woodlands Health
Ventures, Inspire Pharmaceuticals, IOP, Inc, Ista
Pharmaceuticals, Ocular Therapeutix, Revision optics,
Sirion Therapeutics, Transcend Medical, True Vision
Systems, Visiogen, Vista Research, Vistakon
Introduction and Rationale
• Pterygium surgery using a
conjunctival autograft is
associated with recurrence in
5% of cases.
• Recurrence arises from the
conjunctival tissue surrounding
amnion
the autograft.
• Amnionic membrane
• We propose a method where
transplantation (AMT) has been
AMT is used adjunctively as a
used in place of the
biologic implant underneath the
conjunctival autograft , but
conjunctiva surrounding the
recurrence rates are similar to
autograft and not beneath the
those with autografts. This is
autograft. In this location
possibly because the amnion
protected from the ocular
wears away from the ocular
surface, the AMT may provide
surface within 2-3 weeks of
more prolonged anti-fibrotic
surgery.
effects.
Hovanesian, 2008
Methods
• We reviewed records of
all patients who
underwent this
procedure in our office
over a 19 month period
• Procedures were
performed by a single
surgeon (JAH).
• Postop Management
• Patch/shield
overnight
• Drops
• Pred Forte QID
• Zymar QID
• First follow-up 1
week
Hovanesian, 2008
A conjunctival autograft is fashioned and left attached at the superior limbus
while a graft of amniotic membrane is cut into a “c” shape and tucked into
the subconjunctival space surrounding the site of pterygium excision.
After this graft of amnion is fully placed in the subconjunctival space, the
superior limbal graft is cut free and secured over the conjunctival defect
with fibrin tissue adhesive.
Hovanesian, 2008
Results
preop
•
•
•
•
98 eyes of 94 patients
Mean follow-up 9 months (range 6-19)
All grafts remained viable and in place.
Postop appearance and inflammation
was similar to standard conjunctival
autograft.
• Nasal conjunctival graft retraction
occurred in 19 eyes but did not require
re-intervention.
• One pyogenic granuloma occurred at the
nasal edge of one graft. This resolved
spontaneously.
• No recurrences occurred in any eyes.
two week postop
Hovanesian, 2008
Conclusions
Pterygium excision using combined conjunctival
autograft and adjacent subconjunctival amnionic
membrane transplantation is a viable technique for
treatment of pterygium. Results compare favorably
with established techniques.
John A. Hovanesian, M.D.
(949) 951-2020
[email protected]
More information on this technique available at
www.bettereyesurgery.com