A conjunctival graft procedure involves transplanting a small piece of tissue from a healthy area of the eye to repair or replace damaged tissue elsewhere on the eye’s surface. This surgical technique aims to restore the eye’s health and function by providing a protective covering or structural support. The conjunctiva is a clear, thin membrane that covers the white part of the eye and the inside of the eyelids. The procedure is a reconstructive approach that promotes healing and improves the overall integrity of the ocular surface.
Conditions Treated with a Conjunctival Graft
Conjunctival grafts are used to address eye conditions where the natural surface tissue has been compromised. One common application is in the treatment of pterygium, a non-cancerous, wing-shaped growth of conjunctival and fibrovascular tissue that can extend onto the cornea. Pterygium can cause vision problems like astigmatism or even block vision if it grows large enough.
After the surgical removal of a pterygium, a conjunctival autograft is placed over the bare area to prevent recurrence. This method has demonstrated effectiveness in reducing recurrence rates compared to leaving the area exposed. Another condition treated is symblepharon, where the conjunctiva adheres to itself or the cornea, restricting eye movement and potentially causing double vision. Grafts can help release these adhesions and restore normal eye mobility. The procedure is also employed for other significant conjunctival defects or scarring, where providing a healthy tissue barrier is beneficial for healing and preventing further damage.
The Graft Procedure
The conjunctival graft procedure begins with the preparation of the eye, performed under an operating microscope to allow for precise manipulation of delicate tissues. The surgeon will first address the affected area, such as excising a pterygium and any underlying degenerated tissue to create a smooth, clear surface. This step helps minimize recurrence.
Next, the graft tissue is harvested from a healthy part of the conjunctiva, most commonly from the upper eyelid or the superior-temporal quadrant of the same eye. The goal is to obtain a thin piece of conjunctiva, ideally without including excessive underlying Tenon’s tissue, to prevent postoperative swelling and retraction of the graft. The harvested graft is then transferred to the recipient site.
Once positioned, the graft is secured to the sclera, the white outer layer of the eye, while ensuring the tissue’s correct orientation. This can be achieved using dissolvable sutures, such as 7.0 to 10.0 nylon or Vicryl. Alternatively, fibrin glue, a biological adhesive, is used to secure the graft. Fibrin glue can reduce operative time and improve patient comfort by avoiding suture-related issues. The excess graft tissue is then trimmed for a good cosmetic outcome.
Recovery and Post-Operative Care
Following a conjunctival graft procedure, patients can expect common sensations during recovery. It is normal to experience mild discomfort, a scratchy or gritty feeling, blurred vision, and redness in the operated eye. These symptoms subside over a few weeks. Light sensitivity is also common, and wearing sunglasses can provide comfort.
Patients are advised to rest quietly for the rest of the surgery day. An eye patch or shield may be applied immediately after the procedure to protect the eye, removed the next morning. To prevent infection and reduce inflammation, prescribed eye drops, a combination of antibiotics and anti-inflammatory steroids, are administered for several weeks, sometimes up to a few months. It is important to wash hands thoroughly before applying any eye drops.
Activity restrictions are in place to ensure proper healing and prevent graft displacement. Patients should avoid rubbing, pressing, or bumping the operative eye. Strenuous exercise, heavy lifting, and activities that involve bending below the waist should be avoided for several weeks, generally 2-8 weeks depending on the specific activity and surgeon’s advice. Swimming is restricted for at least 2 to 4 weeks, and eye makeup should be avoided for a similar period. Follow-up appointments are scheduled to monitor the healing process and adjust care as needed.
Expected Outcomes and Potential Considerations
Conjunctival graft procedures have a high success rate in preventing the recurrence of pterygium and restoring the normal ocular surface. When used for pterygium, the recurrence rate after conjunctival autografting can be low, with studies reporting ranges from 0% to 39%, demonstrating its effectiveness. In cases of severe symblepharon, the procedure can effectively release adhesions and resolve issues like double vision.
While successful, potential considerations exist. These can include graft displacement or retraction, where the transplanted tissue shifts or pulls away from its secured position. Although uncommon, infection is another possibility, which can be managed with antibiotics. Persistent discomfort or inflammation beyond the typical recovery period can also occur. In some instances, scarring may still result, which could impact vision depending on the extent of the original damage. These less common outcomes are addressed through further medical treatment or additional surgical intervention.