After pterygium removal the conjunctival graft to cover bare sclera will be secured with interrupted 8.0 polyglactin sutures.

After pterygium removal the conjunctival graft to cover bare sclera will be secured with bipolar electrocautery, power set at 25 until whitening of tissue observed.

• Pterygium dissected off, corneal bed burred smooth and autograft harvested as per usual technique.

• Conjunctiva undermined at the recipient site.

• Relaxing incisions placed at the corners of the recipient site.

• Graft is slid into place

• Graft / host interface is gently dried with a Qtip

• Bipolar cautery is applied after grasping the graft and host conjunctiva gently between cautery forceps.

  • Power setting: 25.
  • Duration of cautery: 4 -5 seconds; the tissue should whiten and contract as desiccation and coagulation take place. Some charring may occur.

• Counter traction is applied to the conjunctiva as the cautery forceps are gently teased off

• Cautery is applied at the 4 apices of the graft then in between these points.

Grading of patients' symptoms (pain, foreign body sensation, irritation, and epiphora) will be done using a 5-point scale. The scale ranges from 0 to 4:

0 = no symptom at all;

1. = presence of the symptom but easily tolerated;
2. = presence of the symptom causing some discomfort;
3. = presence of the symptom causing discomfort that interferes with usual activity or sleep;
4. = presence of the symptom that completely interferes with usual activity or sleep.

Grading of patients' symptoms (pain, foreign body sensation, irritation, and epiphora) will be done using a 5-point scale. The scale ranges from 0 to 4:

0 = no symptom at all;

1. = presence of the symptom but easily tolerated;
2. = presence of the symptom causing some discomfort;
3. = presence of the symptom causing discomfort that interferes with usual activity or sleep;
4. = presence of the symptom that completely interferes with usual activity or sleep.

Grading of patients' symptoms (pain, foreign body sensation, irritation, and epiphora) will be done using a 5-point scale. The scale ranges from 0 to 4:

0 = no symptom at all;

1. = presence of the symptom but easily tolerated;
2. = presence of the symptom causing some discomfort;
3. = presence of the symptom causing discomfort that interferes with usual activity or sleep;
4. = presence of the symptom that completely interferes with usual activity or sleep.

Grading of patients' symptoms (pain, foreign body sensation, irritation, and epiphora) will be done using a 5-point scale. The scale ranges from 0 to 4:

0 = no symptom at all;

1. = presence of the symptom but easily tolerated;
2. = presence of the symptom causing some discomfort;
3. = presence of the symptom causing discomfort that interferes with usual activity or sleep;
4. = presence of the symptom that completely interferes with usual activity or sleep.

Analysis. start time of operation, start time of conjunctival graft attachment and end time of operation will be recorded.

Cost Benefit Analysis. Total cost of pterygium surgery using sutures for graft attachment versus cost using cautery for graft attachment will be calculated and compared.