Purpose

To assess the normal healing process of limbal–conjunctival autograft (LCA) after pterygium removal during the early postoperative period using anterior segment optical coherence tomography angiography (OCTA).

Methods

Prospective case series of seven patients undergoing pterygium removal with LCA transplantation procedure, imaged with anterior segment OCTA, and anterior segment colour photos prior to the procedure and on postoperative day (POD) 1, 3, 7 and 30. Revascularization of the graft was analysed quantitatively and qualitatively to estimate patterns of blood vessel growth. Association between revascularization to graft thickness was also investigated.

Results

On POD 1, all autografts showed either minimal flow signal or no signal at all (Mean 7.1 ± 3.3%). Regrowth of blood vessels into the graft was detected on OCTA scans on POD3 (8.7 ± 3.6%) to 7 (14.3 ± 4.1%), as nonorganised vessels formation in their appearance. Blood vessels were seen growing in a centrifugal pattern towards the surrounding conjunctiva, originating from the underlying episcleral vessels. Revascularization flow signal was seen throughout nearly all graft extent on day 30 (21.6 ± 2.2%). Graft oedema was evident on the first week (Mean 611 ± 120 μm, 695 ± 84 μm, 639 ± 96 μm of POD 1, 3 and 7, respectively), reducing substantially by day 30 (300 ± 108 μm).

Conclusions

OCTA imaging can be used to assess the LCA healing process during the early postoperative period. Revascularization occurring as early as 3–7 days post-surgery, seems to originate from the underlying episcleral vessels. Therefore, careful handling of the bare scleral surface during surgery may be prudent for achieving an adequate healing process.

中文翻译：

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角膜缘-结膜自体移植愈合过程——术后早期OCT血管造影研究

目的

使用眼前节光学相干断层扫描血管造影（OCTA）评估术后早期翼状胬肉切除后自体角膜缘 - 结膜移植（LCA）的正常愈合过程。

方法

7 名接受 LCA 移植手术切除翼状胬肉的患者的前瞻性病例系列，在手术前和术后第 1、3、7 和 30 天用眼前节 OCTA 和眼前节彩色照片成像。分析了移植物的血运重建定量和定性地估计血管生长的模式。还研究了血运重建与移植物厚度之间的关联。

结果

在 POD 1 上，所有自体移植物都显示出最小的流量信号或根本没有信号（平均 7.1 ± 3.3%）。在 POD3 (8.7 ± 3.6%) 至 7 (14.3 ± 4.1%) 的 OCTA 扫描中检测到血管再生到移植物中，因为它们的外观形成了无组织的血管。血管以离心方式向周围结膜生长，起源于下方的巩膜外层血管。在第 30 天，几乎所有移植物范围都观察到血运重建血流信号 (21.6 ± 2.2%)。移植物水肿在第一周很明显（POD 1、3 和 7 的平均值分别为 611 ± 120 μm、695 ± 84 μm、639 ± 96 μm），到第 30 天显着减少（300 ± 108 μm）。

结论

OCTA 成像可用于评估术后早期 LCA 的愈合过程。早在手术后 3-7 天发生的血运重建似乎起源于下方的巩膜外血管。因此，在手术过程中小心处理裸露的巩膜表面对于实现充分的愈合过程可能是谨慎的。