Pterygium surgery excision with conjunctival autografting with the help of fibrin glue
by Tushar Agarwal Kudlu, Tushar Shikha Gupta, Tushar Namrata Sharma

Textbook of Pterygium Management

by Namrata Sharma, Tushar Agarwal, Shikha Gupta
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This video demonstrates pterygium surgery excision with conjunctival autografting using glue. This surgery is being under local anesthesia. Left eye of a patient with a vascular wing-shaped pterygium covering approximately 4 mm of nasal corneal surface. A Sinskey hook dipped in Gentian violet paint is used to demarcate with broad lines the area of pterygium from normal conjunctiva that needs to be excised. The head of the pterygium is grasped with Lim’s forceps and excised using angled Vannas scissors at the neck where demarcation line is drawn. The actively bleeding vessels on the exposed corneoscleral pterygium bed are cauterized using bipolar cautery. The remnants of the pterygium are scrapped off the corneal surface using a crescent knife with the blade held vertically to aid in superficial dissection. A motorized diamond burr helps achieve the final polished corneal surface by removing the irregularities by remaining fibrovascular tissue. Conjunctival graft sized equal to the conjunctival defect created at pterygium site is harvested from the superolateral quadrant by marking it using bold demarcation lines using sinskey hook dipped in GV paint. The conjunctival graft is being cut with angled Vannas scissors initially on two of its edges. The underlying Tenon’s tissue is being dissected from underneath the conjunctiva using an angled Vannas’s scissors as tautness is provided by the attached edges till the graft is thin enough to visualize the blades of the scissors through the graft. Finally, the conjunctival graft is cut at the juxtalimbal edge by holding it inverted onto the cornea. Note that the graft is thin enough to allow visibility of underlying cornea through it. The graft is slided into position juxtaposed to the conjunctival defect at host site. Few drops of thrombin are being applied onto the host bed.

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