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Purpose To evaluate clinical outcomes of primary pterygium excision surgery and analyze risk factors for pterygium recurrence. Setting Eye Treatment Centre, Cornea and External Diseases Service, Whipps Cross Hospital, London, United Kingdom. Methods Retrospective case series of eyes undergoing primary pterygium excision between August 2017 and July 2022. Patients who underwent "pterygium excision" documented in the electronic patient record system were identified. Patients with recurrent pterygium and those lost-to-follow-up were excluded. The duration of follow-up, type of surgery performed (primary conjunctival closure, conjunctival autograft, and amniotic membrane transplantation), recurrences with respect to the type of surgery performed, and postoperative complications were collected and analyzed. Results In total, 83 eyes (from 79 patients) were included. The mean age of our patient cohort was 59.3 ± 5.9 years. The most common ethnic distribution was Black Caribbean (15.7%). Conjunctival autograft was performed in 76 eyes (91.6%), primary conjunctival closure was performed in five eyes (6%) and amniotic membrane transplantation was performed in two eyes (2.4%). The recurrence rate with conjunctival autograft was 1.3% with a median time to recurrence of 2.98 months. Recurrence was significantly more common in patients below the age of 40 years (p=0.03). Recurrence was not significantly associated with gender (p=0.23), ethnicity (p=0.17), or grade of surgeon (p=0.38).  Conclusion Our findings demonstrate the effectiveness of conjunctival autograft with fibrin glue fixation for the surgical management of primary pterygium. Recurrence was found to be significantly more common in patients under the age of 40 years old. However, recurrence was not associated with ethnicity, gender, or surgeon grade.

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PURPOSE: To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD). METHODS: Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies. RESULTS: After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections. CONCLUSIONS: Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

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(1) Background: To evaluate the efficacy of conjunctival limbal autograft (CLAU) combined with the amnion-assisted conjunctival epithelial redirection (ACER) procedure for patients with unilateral total limbal stem cell deficiency (LSCD) caused by severe chemical burn. (2) Methods: A retrospective interventional case series of unilateral total LSCD after chemical burn who underwent CLAU combined with ACER surgery between September 2021 and July 2023 was collected. Outcome measures included epithelialization of the cornea with donor limbus-derived epithelium, best corrected visual acuity (BCVA), and complications. (3) Results: Nine males and one female were included in this study. The mean age was 40.9 ± 9.63 (range, 26 to 55) years. The average duration between injury and CLAU combined with the ACER procedure was 7.67 ± 3.97 (range, 4 to 18) months. All patients achieved corneal epithelialization and improved BCVA. Postoperative complications occurred in four cases, including delayed corneal epithelial healing in one case, delayed amniotic membrane dissolution and detachment in two cases, and recurrence of symblepharon in one case. No complications were noted in the healthy donor eyes. (4) Conclusions: CLAU combined with ACER is a safe and effective treatment for unilateral total LSCD caused by severe chemical burn. This combined surgery restores visual function for patients with corneal blindness caused by chemical burn, reducing the burden on the families and society.

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Introduction: Toxic epidermal necrolysis (TEN), also known as Steven Johnson syndrome (SJS), is a devastating disease. Patients develop blindness and symblepharon despite multiple reconstructive surgeries. We report a case of SJS/TEN with ocular involvement where treatment with hyperbaric oxygen therapy (HBOT) resulted in a significant improvement in the visual acuity after surgery. Case presentation: A woman with SJS/TEN with severe ocular complication (SOC) had limbal stem cell deficiency and symblepharon of the superior and inferior fornix. Pannus grew over her cornea, reducing the vision to counting finger. The symblepharon produced shortening of the fornix, causing entropion. The in-turned eyelid caused her eyelashes to rub against the cornea, causing great damage to the ocular surface. Limbal stem cell deficiency led to the loss of normal corneal morphology and invasion of the pannus onto the central visual axis, resulting in poor vision. She experienced ocular inflammation for 3 months before transfer to our hospital for admission. Ophthalmic examination showed bilateral corneal opacity with conjunctivalization, and inferior and superior fornix shortening. Symblepharon-lysis with amniotic membrane transplantation was attempted but the outcome was poor, with recurrence of superior scaring and symblepharon. She finally underwent major reconstructive surgery with allogeneic limbal stem cell transplantation with her sister as the donor, autologous minor salivary gland transplantation, and oral buccal mucosa flap transplant. HBOT was given daily post-surgery for supporting the grafts and suppressing inflammation. After 17 HBOT sessions and 3 months of autoserum drops, her left eye vision increased from the initial counting finger to 0.4 due to the successful growth of the corneal epithelium from the donor corneal limbal cell line. When a scleral contact lens which vaulted over the corneal limbal area was fitted, her vision improved to 0.8 due to redressal of high order aberration and astigmatism from the cornea scar. Conclusion: After major reconstruction of the ocular surface with multiple cell type transplants, including limbal stem cells, minor salivary gland acinar cells, and oral mucosa cells, HBOT proved useful in supporting the graft uptake and oxygenation of the donor tissues, enabling fast recovery of the grafts and cell functioning, with eventual return of the working vision of the patient.

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Limbal stem cell deficiency (LSCD) causes severe vision impairment and can lead to blindness, representing one of the most challenging ocular surface disorders. Stem cell deficiency can be congenital or, more often, acquired. The categorization of ocular surface transplantation techniques is crucial to achieving treatment homogeneity and quality of care, according to the anatomic source of the tissue being transplanted, genetic source, autologous or allogenic transplantation (to reflect histocompatibility in the latter group), and cell culture and tissue engi neering techniques. The aim of this minireview is to provide a summary of the management of LSCD, from clinical characteristics and therapeutic outcomes to the development of novel therapeutic approaches. The manuscript also briefly summarizes recent findings in the current literature and outlines the future challenges to overcome in the management of the major types of ocular surface failure.

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(1) Background: This study aimed to evaluate the clinical outcome of Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) transplantation for recurrent pterygium with restrictive strabismus. (2) Methods: This retrospective study included 11 eyes in 11 patients diagnosed with recurrent pterygium with restrictive strabismus who received sandwich transplantation. The outcomes were measured by pterygium recurrence, best-corrected visual acuity, esotropia (prism diopters), and treatment complications. (3) Results: Eleven patients (six males, five females) had a mean age of 60.5 (range 36-80) years. The previously received pterygium excision surgery number was 1.8 ± 1.02 (range 1-4). The mean follow-up period was 19.9 ± 8.41 (range 12-36) months. All patients had a restriction of abduction in the previously operated eye, causing esotropia in the primary position. Pre-operative esotropia was 17.2 (range 10-30) prims diopter (PD). Five eyes (45.5%) had symblepharon before surgery. All patients were orthotropic until the last follow-up. Symblepharon was released in all eyes. Free ocular motility was present in all eyes. No donor site scar formation, scleral melt, or corneal ulcer was noted. (4) Conclusions: Sandwich transplantation for recurrent pterygium with restrictive strabismus is safe and effective.

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PURPOSE: The aim of the study is to evaluate the effect of limbal autograft location on corneal astigmatism in inferior and superior conjunctival autografted pterygium surgery. METHODS: Patients were divided into 2 groups as diagnosed with primary pterygium and planned to receive surgical treatment. Pterygium surgery was performed on 25 patients with superior and 25 patients with inferior limbal autograft who have similar epidemiologic features. Cornea anterior and posterior surface keratometry (K) 1, K2, Kmax, peripheric radius (Rper) (the mean radius of curvature of the 7.0-9.0 mm ring area), refractive astigmatism and axis values, were examined. Corneal irregularity indices were the index of surface variance (ISV), index of vertical asymmetry (IVA, mm), index of height asymmetry (IHA, µm), index of height decentration (IHD, µm). The data were compared pre- and postoperative and the effect of graft location on results was evaluated. RESULTS: K1 which is from the values of the cornea front face has risen after surgery both of superior and inferior groups (p = 0.011). However, no postoperative significant difference was detected in terms of the change. Otherwise, both groups have changed regarding astigmatism and Rper (p < 0.001), but no postoperative significant difference was found in terms of the change. There were not any differences between groups regarding the changes of postoperative back face values. Although there were significant decreases in ISV, IVA, and IHD values in both groups in terms of all corneal surface indices, there was no significant difference between the lower and upper groups in terms of postoperative results (p > 0.05). CONCLUSION: The effects of pterygium surgery with limbal autograft provide significant improvement on corneal astigmatism. However, we think that the location of the conjunctiva has no effect, but in cases where the bulbar conjunctiva needs to be preserved or cannot be used, the choice of the lower bulbar conjunctiva can achieve successful results.

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INTRODUCTION: This study aimed to evaluate the surgical treatment results for conjunctival limbal autograft (CLAU) and keratolimbal allograft (KLAL) in various types of limbal stem cell deficiency (LSCD) etiologies performed in order to achieve a stable ocular surface prior to KPro implantation. METHODS: We analyzed the outcomes of the surgical treatment of 43 eyes of 39 patients with LSCD as an initial treatment preparing patients' ocular surface for KPro implantation. The most common causes were ocular trauma (50.7%), mainly alkali burns (77%); autoimmune causes, mainly ocular cicatricial pemphigoid (OCP; 17.4%); infection (15.9%) including Lyell's syndrome/Stevens-Johnson syndrome (LS/SJS; 16%). In all 17 eyes operated on with CLAU, this procedure was performed once. Similarly, one uncomplicated KLAL procedure in one eye was performed in 10 women and 19 men. In another one woman and three men, KLAL was performed in both eyes. In one man with Lyell's syndrome, the KLAL operation was performed three times in one eye. Follow-up was at least 12 months. RESULTS: Visual acuity (VA) improved in 17 eyes (31%) and remained unchanged in 38 eyes (69%). VA improved from light perception to hand movements in three eyes (16%) from the CLAU group of patients and eight eyes (15%) from the KLAL group; VA improved from hand movements to finger counting in two eyes (12%) post CLAU and two eyes (4%) post KLAL operation. The most common complication of surgical treatment was persistent epithelial defect that was refractory to medical treatment in 32 eyes (58%), 5 eyes post CLAU and 27 post KLAL. Corneal conjunctivalization (19%) and neovascularization (29%) were present on the corneal edge of the graft. Symblephara recurred within 3 months in nine eyes (17.3%) after KLAL, including four eyes that had been chemically burned and five eyes with LS/SJS. DISCUSSION: Pretreatment with CLAU or KLAL procedures in severely damaged ocular surfaces allows the ocular surface to be prepared for safe KPro implantation with sufficient tissue surroundings with less conjunctivalization and deeper conjunctival fornices.

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INTRODUCTION AND IMPORTANCE: This case describes a novel technique combining a mini-conjunctival limbal autograft (CLAU) with a deep anterior lamellar keratoplasty (DALK) in a case of chemical injury sequelae. CASE PRESENTATION: A 19-year-old female presented with total limbal stem cell deficiency (LSCD) and a vascularized corneal scar in the visual axis of the left eye, 4 years following a chemical injury. In order to treat the LSCD and simultaneously visually rehabilitate the patient, a mini-CLAU with DALK was carried out. Two separate one clock-hour CLAUs were harvested from the right eye and secured in the left. The graft was clear in the initial postoperative period and maintained its clarity over 15 months of follow period with a visual acuity of 20/30 with scleral contact lenses. The mini-CLAUs sustained a stable and well epithelialized corneal surface during the same period. CLINICAL DISCUSSION: The use of the mini-CLAUs instead of the traditional CLAU circumvents the complication of an iatrogenic LSCD in the donor eye as the size of the donor grafts is smaller (1-2 clock hours versus 6-8 clock hours). Despite the smaller size, these grafts are efficacious in maintaining a well epithelialized corneal surface even in cases of total LSCD. The autologous nature of the graft defers the need for immunosuppression and its peripheral location facilitates ease of the surgical technique when combined with a keratoplasty. CONCLUSION: This novel single-staged procedure is an effective technique to reestablish a stable ocular surface and to visually rehabilitate cases of chronic chemical injury with good long-term outcomes.

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PURPOSE: Analysis of complication profile after pterygium excision, in primary and recurrent pterygia. METHODS: Retrospective analysis of all the patients who had undergone pterygium excision in a tertiary center in South India from 2010 to 2018 was analyzed. A total of 2356 eyes in 2028 patients were included in the study. Patients who had undergone conjunctival autografting for primary pterygium, conjunctival limbal autografting for recurrent pterygium, vertical split conjunctival autografting for double head pterygium were included in the study. In all the surgical procedures fibrin glue was used for fixation of the autograft. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study. RESULTS: The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). Granuloma was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Recurrence was seen in 34 patients (1.44%). Other severe complications like corneal melt were seen in only 1 case (0.04%) who was operated on for recurrent pterygium. In comparison between primary and recurrent pterygia; subconjunctival hemorrhage, edema of the graft, graft loss, and recurrence was significantly (P < 0.05%) higher in recurrent pterygia. CONCLUSION: Various complications can occur post pterygium surgery as listed above. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.

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A 73-year-old male with a history of myopic laser-assisted in situ keratomileusis (LASIK) 20 years earlier presented with a late LASIK flap dehiscence, epithelial ingrowth, conjunctivalization, and the development of a pseudopterygium in the right eye. The findings were consistent with surgical trauma, likely occurring after corneal epithelial debridement to improve visualization during pars plana vitrectomy for retinal detachment repair 3 months earlier. The patient underwent epithelial ingrowth debridement, LASIK flap reapproximation and suturing, and a conjunctival limbal autograft from the contralateral eye. The surgery was completed successfully without the need for flap amputation. Postoperatively, the patient had an uneventful course with a well-healing conjunctival graft and no interface opacity or evidence of recurrent pseudopterygium of the right eye. The graft and corneal topography remained stable after subsequent cataract surgery.

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Corneal dellen are a rare and serious complication after primary pterygium surgery with conjunctival limbal autograft (CLAG) with fibrin glue without antimetabolites. Dellen are caused by interruptions of the tear film and local dehydration of the cornea. If untreated, they may lead to corneal perforation. We describe the case of a patient who developed corneal dellen 15 days after uneventful pterygium excision with CLAG with fibrin glue without the use of antimetabolites. There was no satisfactory response to lubricants and patching, and the patient had no associated systemic risk factors. As the thinning increased, cyanoacrylate glue with bandage contact lens was applied, but the dellen reappeared seven days after glue removal. Dellen finally resolved with thermal punctal cautery applied to both puncta. Dellen most commonly respond to artificial tears, antibiotic ointment, and patch application. However, in refractory cases, punctal cauterization can be considered as a good option to increase tear pooling in the area of dellen, thereby promoting healing.

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AIM: The aim of the study is to report the results of conjunctival-limbal autograft (CLAU) transplantation and penetrating keratoplasty (PK) in eyes with limbal stem cell deficiency (LSCD) due to chemical or thermal injury. METHODS: Thirty-one eyes of the 31 patients, who had unilateral LSCD due to chemical or thermal injury, were included in the study. Bilaterally affected cases and LSCD due to Steven-Johnson syndrome and mucous membrane pemphigoid were excluded from the study. All patients underwent a complete ophthalmologic examination. The surgical procedures, postoperative complications, ocular surface status, and visual outcomes were noted. RESULTS: In the CLAU group, regular corneal epithelium and ambulatory vision (≤1.0 logarithm of the minimum angle of resolution [20/200]) were achieved in 81% of eyes, including 22 eyes (71%) that were assessed after a mean follow-up period of 58 months, respectively. The 5-year survival rate of corneal allograft was 33%, 4 ± 13.9 in the CLAU applied eyes. In addition, the corneal graft clarity maintenance rate was found to be higher in patients having ≥12 months duration between CLAU and PK, which is statistically significant (62% vs. 23%, P = 0.046). CONCLUSION: Waiting at least 1 year after CLAU transplantation to perform PK increases corneal clarity. Eyelid problems, even if the eyelids were reconstructed properly, remain a major risk factor for the development of the epithelial disorder in the early and late postoperative period in CLAU applied eyes.

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PURPOSE: To conduct a systematic review on outcomes of three different techniques of autologous limbal stem cell transplantation (LSCT): conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation (SLET), in unilateral limbal stem cell deficiency (LSCD). METHODS: Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science and Cochrane Central Register. Standard systematic review methodology was followed using Meta-analysis of Observational Studies in Epidemiology guidelines. Studies with a sample size of more than 10 eyes were included. The primary outcome measure of efficacy was restoration of a completely epithelised, stable and avascular corneal surface (anatomical success). The secondary outcome measure of efficacy was improvement in best-corrected visual acuity of two-lines or greater (functional success). RESULTS: The review identified 22 non-comparative case series, which included 1023 eyes. Ocular burns were the major (88%) indication for surgery. Overall, at a median postoperative follow-up of 1.75 years, autologous LSCT for unilateral LSCD showed anatomical and functional success rates of 69% and 60%, respectively, without any serious adverse events in the donor eye. The follow-up duration and indications for surgery were comparable across all groups (p>0.05). The anatomical and functional success rates of SLET (78%; 68.6%) and CLAu (81%; 74.4%) were comparable, and significantly better than those of CLET (61.4%; 53%; p=0.0048). CONCLUSION: Autologous LSCT is a safe and effective treatment for unilateral LSCD. In the absence of randomised controlled trials, existing evidence clearly suggests that clinical outcomes are better with SLET and CLAu as compared with CLET.

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PURPOSE: To investigate the long-term clinical outcomes of conjunctival limbal autograft (CLAU) in patients with unilateral total limbal stem cell deficiency (LSCD). METHODS: In this retrospective interventional case series, the medical charts of patients with unilateral total LSCD were reviewed. Patients who underwent CLAU and no other allograft ocular stem cell transplantation with a minimum follow-up of 1 year were included. Main outcome measures were ocular surface stability, best-corrected visual acuity (BCVA), and postoperative complications. RESULTS: 27 eyes fulfilled the inclusion criteria with a mean follow-up period of 49.8 ±â€¯36.6 months (4.15 years; range 12-186.72 months; 1-15.56 years). Ocular surface stability was achieved in 77.8% (n = 21) of eyes at last follow-up, while 22.2% (n = 6) developed partial surface failure. Optical penetrating or deep lamellar anterior keratoplasty was performed in 44.45% (n = 12). BCVA improved from 1.42 ±â€¯0.95 mean LogMAR (equivalent to 20/400) preoperatively to 0.53 ±â€¯0.47 mean LogMAR (equivalent to 20/70) at last follow-up (p < 0.001). BCVA ≥20/40 was achieved in 44.45% (n = 12) at last follow-up. Microbial keratitis occurred in 14.81% (n = 4). Ocular hypertension secondary to corticosteroid use developed in 25.9% (7/27) eyes. There were no other complications in the donor or recipient eyes. CONCLUSIONS: CLAU can provide long-term ocular surface stability and successful visual outcomes in patients with unilateral LSCD.

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A 25-year-old male patient presented at the clinic with chemical trauma to the left eye. His visual acuity according to Snellen chart measurement was 0.05/10 in the left eye and 10/10 in the right eye. On slit lamp examination, conjunctival hyperemia and limbal ischemia were observed between the 1 o'clock and 6 o'clock hours (approximately 5 clock hours). The cornea was edematous in this area, and a corneal epithelial defect adjacent to the limbal ischemia area was present. The anterior chamber, iris, and lens were normal; the fundus could not be concurrently evaluated. Conjunctivalization and excessive neovascularization were observed in the limbal ischemic area at the end of the fourth week of medical treatment. Visual acuity in the left eye was 0.3 and the epithelial defect had healed. At the end of the sixth week, a conjunctival limbal autograft (CLAU) combined with amniotic membrane (AM) transplantation surgery was performed. Subsequently, the corneal neovascularization was noted to have completely vanished in the ischemic area where the CLAU and AM transplantation were performed. Visual acuity improved to 0.7 and the symptoms of the patient decreased.

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PURPOSE: To determine the role of primary limbal stem cell transplantation (LSCT) in managing extensive ocular surface squamous neoplasia (OSSN) with more than 3 quadrants of limbal involvement to prevent manifestations of limbal stem cell deficiency. METHODS: A multi-center, comparative, and interventional clinical study of cases and historical controls was done. Patients with a limbal mass suggestive of OSSN involving more than 3 quadrants of limbus (> 9 clock hours) and no local, regional or systemic metastasis, who underwent primary surgical excision with or without adjuvant chemotherapy and had a minimum follow-up of 12 months were included in this study. Two historical controls underwent tumor excision with only amniotic membrane grafting. Three cases underwent tumor excision along with LSCT in the form of conjunctival limbal autograft (CLAG) or simple limbal epithelial transplant (SLET). RESULTS: None of the eyes had any recurrences of OSSN during the follow-up period. Cases with primary LSCT with tumor excision showed better ocular surface stability in the long term. CONCLUSION: Concomitant LSCT either in the form of CLAG or SLET appears to provide better long-term outcomes and is advocated while excision of extensive OSSN involving the limbus.

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INTRODUCTION: Ocular surface diseases with limbal insufficiency represent a therapeutic challenge for restoring vision. This corneal deficiency includes both classical ocular diseases (as chemical burns) and rare ocular diseases (as congenital aniridia and ocular cicatricial pemphigoid). AREAS COVERED: Our understanding of limbal epithelial stem cells (LESCs) has increased the potential for treatment options. Pharmacological treatment strategies (as regenerating agent ophthalmic solutions) and especially surgical treatment strategies are available. Isolated LESCs can be produced by limbal primary cultures obtained from explants or cell suspensions. We review the latest cornea surgery techniques. EXPERT OPINION: The adjunction of human limbal mesenchymal cells as a support for limbal stem cell primary cultures appears to be of great interest. Recently, human-induced pluripotent stem cells have allowed the generation of minicorneal organoids. This potential means of creating a three-dimensional cornea with in vitro maturation opens up important research areas for corneal regeneration therapy.

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Corneal epithelial stem cells are adult somatic stem cells located at the limbus and represent the ultimate source of transparent corneal epithelium. When these limbal stem cells become dysfunctional or deficient, limbal stem cell deficiency (LSCD) develops. LSCD is a major cause of corneal scarring and is particularly prevalent in chemical and thermal burns of the ocular surface. LSCD leads to conjunctivalization of the corneal surface, neovascularization, recurrent or persistent epithelial defects, ocular surface inflammation, and scarring that, in turn, lead to decreased vision, pain, and impaired quality of life. Several techniques have been reported for limbal stem cell transplantation (LSCT). We introduce the surgical techniques, examine the success rate, and discuss the postoperative complications of conjunctival limbal autograft (CLAU), cultivated limbal stem cell transplantation (CLET), simple limbal epithelial transplantation (SLET), and limbal allograft, including keratolimbal allografts (KLAL) and living-related conjunctival allograft (LR-CLAL).

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PURPOSE: To describe a simple and effective technique for the prevention of pterygium recurrence. METHODS: This is a retrospective consecutive single-center case series with recurrence rate as the main outcome measure. Dissection of the conjunctiva, the Tenon's layer, and the sclera was continued up to the insertion of medial rectus. The exposed Tenon's layer was excised for 2 to 3 mm. The entire free edges of the conjunctiva was tacked firmly to the sclera. The conjunctival-limbal graft was sutured firmly to the sclera, recipient limbus, and to the conjunctiva incorporating the reciprocal edges. RESULTS: We report findings in a total of 36 patients, with 20 (%55.5) males and 16 (%44.4) females. Median age of the patients was 44.5 years (range 16-80). The mean follow-up period was 23.1 ± 6.5 months. The mean size of pterygium in mm length was 3.8 ± 0.7. Recurrence did not occur in any patient. Diplopia was not reported by any patients. CONCLUSIONS: Conjunctival-limbal autograft combining with selective exicison of Tenon's layer but without damage to any essential tissue such as the semilunar fold or Tenon's capsule pulley is a relatively simple and effective procedure.

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