Conjunctival Autograft versus Combined Amniotic Membrane and Mini-Simple Limbal Epithelial Transplant for Primary Pterygium Excision


Purpose: To compare outcomes of conjunctival autograft (CAG) and combined amniotic membrane with mini-simple limbal epithelial transplant (mini-SLET) after primary pterygium excision.

Methods: All consenting adults with primary pterygium were included in this study. After pterygium excision, patients were randomized to receive either CAG or mini-SLET and both grafts were held in place with fibrin glue. The patients were followed-up at days 1, 3, 7, 14, and 30 and subsequently at the third, sixth, and ninth months. The recurrence rate was considered as the primary outcome measure whereas the operating time, postoperative symptoms, and surgical complications were considered the secondary outcome measures.

Results: The study comprised of 264 eyes of 264 patients, of which 233 (88%) completed the nine months of follow-up. Of these, 118 (51%) received CAG and 115 (49%) received mini-SLET. The groups were comparable at baseline. Recurrence of pterygium was seen in two (1.6%) eyes in the CAG group and three (2.6%) eyes in the mini-SLET group (P = 0.68). Operative time for mini-SLET (20.33 ± 1.28 min) was significantly higher than that for CAG (12.01 ± 1.26 min) (P < 0.001). Graft displacement was observed in one case in group II (P = 0.999). The Lim Bon Siong (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was statistically significant for all four symptoms at days 1 and 3; however, on day 7, foreign body sensation, pain, and irritation scores were significantly higher for the CAG group.

Conclusion: In this study, the overall recurrence rate was very low and comparable between mini-SLET and the established technique of CAG after performing the primary pterygium excision. Despite a longer surgical time, mini- SLET appears to be a viable option for the management of primary pterygium.


Conjunctival Autograft (CAG), Mini-Simple Limbal Epithelial Transplant (mini- SLET), Pterygium

1. Jaros PA, DeLuise VP. Pingueculae and pterygia. Surv Ophthalmol 1988;33:41–49.

2. Viani GA, Fonseca EC, De Fendi LI, Rocha EM. Conjunctival autograft alone or combined with adjuvant beta-radiation? A randomized clinical trial. Int J Radiat Oncol Bio Phys 2012;82:507–511.

3. Donnenfeld ED, Perry HD, Fromer S, Doshi S, Solomon R, Biser S. Subconjunctival mitomycin C as adjunctive therapy before pterygium excision. Ophthalmology 2003;110:1012–1016.

4. Rubinfeld RS, Pfister RR, Stein RM. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 1992;99:1647–1654.

5. Yu CM, Liang WL, Huang YY, Guan W. Comparison of clinical efficacy of three surgical methods in the treatment of pterygium. Eye Sci 2011;26:193–196.

6. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1995;92:1461–1470.

7. Chen PP, Ariyasu RG, Kaza V. A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 1995;120:151–160.

8. Prabhasawat P, Barton K, Burkett G, Tseng SC. Comparison of conjunctival autografts, amniotic membrane grafts and primary closure for pterygium excision. Ophthalmology 1997;104:974–985.

9. Al Fayez MF. Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 2002;109:1752–1755.

10. Marticorena J, Rodriguez-Ares MT, Tourino R. Pterygium surgery; conjunctival autograft using fibrin adhesive. Cornea 2006;25:34–36.

11. Uy HS, Reyes JMG, Flores JDG. Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology 2005;112:667–671.

12. Bahar I, Weinberger D, Dan G. Pterygium surgery: fibrin glue versus vicryl sutures for conjunctival closure. Cornea 2006;25:1168–1172.

13. Wit D, Athanasiadis I, Sharma A. Sutureless and glue free conjunctival autograft in pterygium surgery: a case series. Eye 2010;24:1474–1477.

14. Malik KPS, Goel R, Gupta A. Efficacy of sutureless and glue free limbal conjunctival autograft for primary pterygium surgery. Nepal J Ophthalmol 2012;24:230–235.

15. Singh PK, Singh S, Vyas C, Singh M. Conjunctival autografting without Fibrin Glue or sutures for Pterygium Surgery. Cornea 2013;32:104–107.

16. Hernández-Bogantes E, Amescua G, Navas A. Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment Br J Ophthalmol 2015;99:1598–1600.

17. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997;115:1235–1240.

18. Aletras AJ, Trilivas I, Christopulou ME. UVB-mediated down regulation of proteasome in cultured human primary pterygium fibroblasts BMC Ophthalmol 2018;18:328.

19. Sati A, Shankar S, Jha A. Comparison of efficacy of three surgical methods of conjunctival autograft fixation in treatment of pterygium. Int Ophthalmol 2014;34:1233–1239.

20. Sangwan VS, Basu S, MacNeil S. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol 2012;96:931–934.

21. Cardenas-Cantu E,Zavala J,Valenzuela J. Molecular Basis of Pterygium Development. Semin Ophthalmol 2014:1–17.

22. Chui J, Coroneo MT, Tat LT. Ophthalmic pterygium: a stem cell disorder with premalignant features. Am J Pathol 2011;178:817–827.

23. Grueterich M, Tseng SC. Human limbal progenitor cells expanded on intact amniotic membrane ex-vivo. Arch Ophthalmol 2002;120:783–790.

24. Shimmura S, Shimazaki J, Ohashi Y, Tsubota K. Anti-inflammatory effects of amniotic membrane transplantation in ocular surface disorders. Cornea 2001;20:408–413.

25. Sati A, Banerjee S, Kumar P. Mini-simple limbal epithelial transplantation versus conjunctival autograft fixation with fibrin glue after primary pterygium excision: a randomized controlled trial. Cornea 2019;38;1345–1350.