Use of Omnigen human amniotic membrane-derived dry matrix for pterygium surgery

Session Details

Session Title: Presented Poster Session: Surgical Cornea

Venue: Poster Village: Pod 2

First Author: : F.Beer UK

Co Author(s): :    N. Maycock   R. Jayaswal                    

Abstract Details

Purpose:

Pterygium surgery typically involves grafting with autologous conjunctiva which has been reported to reduce the recurrence rate from 40% to <10%. Disadvantages of auto-grafting conjunctiva include scarring, ocular irritation and unsatisfactory cosmesis.  We describe a new surgical technique for pterygium surgery using the Omnigen (Nuvision Biotherapies) dried human amniotic membrane graft and describe the results of a case series of 8 patients treated with the technique out to 6 months.

Setting:

All surgeries were performed by two consultant surgeons at a large district general hospital as part of the corneal and anterior segment service.

Methods:

The pterygia were graded according to the Tan protocol for recurrence risk using anterior-segment photography, AS-OCT and Pentacam tomography. Following routine pterygium excision surgery, an Omnigen graft was cut to fit the resection site and applied to the sclera with basement membrane side facing up using Tisseel glue.  Surrounding conjunctival epithelium was mobilised to overlap the edges of the graft and glued in place.  A bandage contact lens was used. Post-operative drops included dexamethasone 0.1% and chloramphenicol 0.5% minims QDS.  Patients were followed up at 1 week, 1, 3 and 6 months.

Results:

The technique took less time to perform than surgery with conjunctival autograft.  It was well tolerated by all patients with low levels of subconjunctival haemorrhage, inflammation and discomfort at 1 week.  AS-OCT showed integration of the dried amnion graft into the subconjunctival space and conjunctival epithelialisation of the graft was completed by 3 months in all patients.  5 patients had no recurrence at 6 months, all of which were primary surgeries with Grade 1 or 2 Pterygia.  3 patients developed recurrence and required subconjunctival 5–Fluorouracil injections.  Risk factors for recurrence included higher grade of pterygium and re-do surgery.

Conclusions:

Pterygium surgery using a dried amniotic membrane graft is well-tolerated and has the benefit of reduced surgical time, reduced inflammation and faster recovery when compared with conjunctival autografting.  It also has a number of advantages over the use of fresh amnion as it is an easy to handle, off-the-shelf product that is readily available in a number of different sizes.  This small case series suggests that in a subgroup of patients with primary, low-grade pterygia, recurrence rates with this technique may be very low.  A larger series would allow for a more definitive comparison of recurrence rates with other techniques.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented