Kenyon et al first described this technique in 1985. Routine excision of the pterygium is first carried out either from the head or from the conjunctival side. Care is taken not to go too deep on the corneal side. All involved conjunctiva, underlying tenon’s capsule and scar tissue (especially in recurrent cases) is excised, taking care to identify and protect the rectus muscle. Tseng et al do an extremely vigorous excision in cases of recurrence, including the caruncle. However, most others generally spare the caruncle for better cosmesis. The size of the bare sclera is measured with calipers.
The globe is then turned down with a fixation suture at 12o’clock limbus. The superior bulbar conjunctiva is marked with marking pen or methylene blue. The conjunctiva is excised outside the marking done and a tenon free graft of the required size excised with Westcott scissors. The limbal stem cells are not included in the graft. The graft should be free of tenon’s capsule and handled gently, preferably with fine non-toothed forceps. This free graft is then rotated into place over the bare sclera, allowing the limbal edge to occupy the limbal position. The graft can be sutured with 8/0 vicryl or 10/0 nylon sutures with buried knots. The donor area is left to epithelize on its own. A plastic conformer is placed in the eye for a few days to prevent adhesions to the raw surface.
This technique is done for both primary and recurrent pterygia. The author has been using this technique since the last ten years. The recurrence rate in the author’s hands is 8%. The complications encountered have been
1. Suture granuloma = 2%
2. Haematoma under graft = 2%
3. Graft retraction = 1%
4. Infection = 0%