Anterior segment indocyanine green angiography in pterygium surgery with conjunctival autograft transplantation

PURPOSE: To assess indocyanine green angiography (ICGA) as a method for monitoring autograft perfusion after pterygium excision with limbal-conjunctival autograft transplantation (LCAT) and to compare ICGA with anterior segment fluorescein angiography (ASFA). DESIGN: Nonrandomized prospective interventional case series. METHODS: Twelve eyes of 11 patients with primary pterygium treated by excision and limbal-conjunctival autograft transplantation were studied in a clinical practice. Anterior segment fluorescein angiography and ICGA findings for autograft vascularization after pterygium surgery were compared in 12 eyes of the 11 patients. Graft perfusion was monitored for 1 month with ASFA and ICGA, on days 1,7, and 30 post-surgery. RESULTS: With ASFA no graft perfusion was observed by postoperative day 30; only five grafts were isofluorescent with some vascularization, while the remaining seven grafts were hypofluorescent without any vascularization. In contrast, ICGA showed that, on postoperative day 1, all 12 grafts were hypofluorescent with multiple hyperfluorescent foci at the graft margin in the late phase and that, by postoperative day 7, 10 grafts were hypofluorescent and appeared to be perfused, originating from the episcleral vascular bed. On day 30, ICGA demonstrated isofluorescent grafts in 10 eyes with some conjunctival and episcleral vascular patterns on the graft itself, including the conjunctiva adjacent to the graft. By this stage, perfusion of the graft was complete. CONCLUSION: Indocyanine green angiography is useful for monitoring graft perfusion after LCAT in pterygium surgery. Further studies are needed to identify the implications of graft perfusion for therapy following LCAT in patients with pterygium.