June-July 2020


Ocular Surface Considerations For Surgery
Tissue Tuck Technique utilizing the best of many approaches

by Neel Desai, MD Eye Institute of West Florida Tampa, Florida

Small variations in technique can make the difference between an excellent outcome or any number of intraoperative difficulties or postoperative complications. We must think about pterygium surgery beyond simple excision of the pterygium and low recurrence rates, broadening the definition of success to include recovery speed, cosmesis, avoiding complications, preserving normal conjunctiva, and restoring functional anatomy. An ideal procedure needs to achieve these endpoints while respecting our limited OR time.
The Tissue Tuck Technique evolved naturally—and by necessity—from lessons learned from leaders in the field like Hirst, Hovanesian, Kenyon, and Tseng. It attempts to integrate critical aspects of their unique techniques. Tissue Tuck is admittedly novel only in how it integrates features of other described techniques to arrive at a 10- to 15-minute procedure that has a low recurrence rate (<1% in more than 900 cases) and fast cosmesis (1–2 weeks), and is reproducible.
To start, a traction suture is placed for better visualization, reduced muscle trauma, and reconstruction of the semi-lunar fold with cryopreserved amniotic membrane while the globe is in full abduction, provides cosmesis and unrestricted movement. Subconjunctival extravasation of 2% epi-lidocaine provides anesthesia and separation of natural tissue planes. An extensive tenonectomy recesses the gap from which recurrences originate, and bipolar cautery is used to tether the fibrovascular root of the pterygium to tenons posteriorly, taking advantage of tenons’ tendency to retract and sealing the gap to recurrence. Finally, the membrane is placed with fibrin glue and meticulously tucked to reconstruct the semi-lunar fold and barricade fibrovascular growth. The membrane functions and handles like a “ready-made” conjunctival autograft without the sacrifice of normal tissue or procedural time. Its active biologics also support rapid re-epithelialization and inhibit inflammation and scarring.

Relevant disclosures

Desai: Bio-Tissue


Desai: desaivision2020@gmail.com

Tissue Tuck Technique utilizing the best of many approaches Tissue Tuck Technique utilizing the best of many approaches
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