A New Method of Conjunctival Graft Harvest With the Davies Conjunctival Forcep

Peter Davies

Purpose: This presentation demonstrates use of the Davies Conjunctival Forcep (DCF) to harvest a thin conjunctival graft. When combined with Fibrinogen glue (Tisseel ®) in pterygium surgery, this technique reduces surgery time and patient morbidity, and achieves high patient satisfaction.

Method: A retrospective case series was analysed of 105 consecutive eyes (97 patients) that underwent pterygium surgery from October 2008 to June 2010. Snellen visual acuity was assessed one-week and two months post surgery. A retrospective questionnaire was utilized to assess discomfort of surgery, pain at day one and week one post-operatively, time off work, time to full recovery, recurrence at one year, and overall patient satisfaction. Those patients with recurrent pterygium who had received prior surgery with conjunctival transplant using sutures were also questioned regarding comparative satisfaction.

Results: Median post-operative pain was recorded as "mild" at one day, and "none" at one week. Median time off work/normal activities was 1-3 days. There was one recurrence associated with graft detachment in the 53 patients followed up for greater than one year. Median follow-up time was 335 days (range 61 – 684 days). The procedure had a 99% satisfaction rate, with 82% percent of patients claiming to be "extremely satisfied". Of the 20 patients undergoing surgery for recurrent pterygium, 100% said that this technique was "extremely better" than previous surgery involving sutures. Typical surgical times ranged from 5-8 minutes for virgin pterygium, and 8-12 minutes for recurrent pterygium.

Conclusion: The Davies Conjunctival Forcep allows harvest of a thin conjunctival graft, and reduces operation times. Securing the conjunctival graft with Tisseel® Fibrinogen glue removes the need for sutures and diathermy in Pterygium Surgery, resulting in low post-operative pain levels and rapid recovery.