Preservation of the Tenon's Capsule and Sub-Tenon's Space after the Autologous Lim-bal-Conjunctival Transplantation in Pterygium Surgery

Abstract

Fernanda S Vidal*, Sebastiao Cronemberger and Jose Aloisio Massote

Purpose: No previous studies have evaluated the scarring of the conjunctiva and Tenon’s Capsule (TC) separately when only the conjunctiva is removed, and TC is preserved in the upper part of the bulb: the site designated for trabeculectomy. Thus, this cohort interventional study aims to investigate the scarring of the donor area after Autologous Limbal-Conjunctival Transplantation (ALCT) using Anterior Segment Optical Coherence Tomography (AS-OCT).

Methods: Twenty-three eyes with pterygium were submitted to resection and local reconstruction with ALCT. AS-OCT images obtained from each eye preoperatively served as postoperative control. ALCT was removed superiorly with preservation of TC. The cure of this donor area occurred by secondary intention. AS-OCT was performed preoperatively and 30 and 180 days postoperatively in the donor area, measuring the thickness of the conjunctiva (epithelium and stroma) and TC. The Sub-Tenon’s Space (STS) was clinically assessed.

Results: The mean thickness of the conjunctival epithelium was 48.04 μm ± 11.37 μm in the preoperative period and 51.87 μm ± 15.04 μm 180 days after surgery, without statistically significant difference (P=0.282). A statistically significant increase (P=0.005) in the mean thickness of the conjunctival stroma, from 85.35 μm ± 23.10 μm in the preoperative period to 101.61 μm ± 20.19 μm 180 days after surgery was found. TC had no significant changes, slightly increasing from 117.13 μm ± 24.26 μm preoperatively to 118.09 μm ± 19.24 μm (P=0.808) 180 days after surgery. STS was found in 19 (82%) eyes 180 days after surgery.

Conclusion: Following ALCT with TC preservation, scarring took place in the conjunctiva, epithelium, and stroma. The TC and the STS were preserved not showing any significant changes.