CPT® Code 68371

1. Indications

The harvesting of a conjunctival allograft is indicated for various ocular conditions that necessitate the replacement or repair of damaged conjunctival tissue. The following are specific indications for this procedure:

• Ocular Surface Reconstruction The procedure is performed to reconstruct the ocular surface in patients with conditions such as severe dry eye, chemical burns, or trauma that have resulted in conjunctival damage.
• Pterygium Surgery It may be indicated during pterygium excision to provide a graft that can help prevent recurrence and promote healing.
• Conjunctival Defects The procedure is utilized to address defects in the conjunctiva caused by surgical excision, disease, or congenital anomalies.

2. Procedure

The procedure for harvesting a conjunctival allograft involves several critical steps to ensure the successful acquisition of the graft tissue. Each step is performed with precision to minimize complications and optimize the quality of the graft.

• Step 1: Preparation and Draping The eye from which the conjunctival allograft will be harvested is meticulously prepared and draped to maintain a sterile field. This preparation is essential to prevent infection and ensure a safe surgical environment.
• Step 2: Marking the Harvest Sites The specific sites for the conjunctival harvest are marked using a pen or keratotomy marker. This step is crucial for guiding the surgeon during the incision process and ensuring that the appropriate amount of tissue is harvested.
• Step 3: Anesthesia and Elevation A subconjunctival injection of balanced salt solution, along with a local anesthetic, is administered to elevate the conjunctiva at the donor site. This elevation facilitates access to the tissue and minimizes discomfort for the donor.
• Step 4: Incision of the Graft Borders The lateral borders of the graft are incised in a radial fashion. This technique allows for a precise cut that will define the edges of the graft and ensure that the tissue can be harvested effectively.
• Step 5: Undermining the Tissue The tissue between the incisions at the lateral borders is undermined using blunt dissection. This careful dissection is carried out in an anterior direction to the conjunctival insertion at the limbus and extends beyond the limbus into the peripheral cornea, ensuring that the graft includes the necessary tissue layers.
• Step 6: Excision of the Graft The conjunctival graft, which includes the superficial epithelial corneal tissue, is then excised. This step requires precision to ensure that the graft is of adequate size and quality for transplantation.
• Step 7: Donor Site Management After the graft is harvested, the donor site may be left to heal by secondary intention, allowing natural healing processes to occur. Alternatively, the conjunctiva may be advanced to cover a portion of the donor site, which can help minimize pain and inflammation.
• Step 8: Graft Preservation The harvested graft is placed in a preservation solution with the epithelial side facing up. This preservation is critical for maintaining the viability of the graft during transport to the recipient surgical suite.

3. Post-Procedure

Post-procedure care for the donor site is essential to ensure proper healing and minimize complications. The donor site may be monitored for signs of infection, inflammation, or excessive pain. If the conjunctiva was advanced to cover the donor site, care should be taken to ensure that the advancement remains intact and that the area is kept clean. Patients may be advised on the use of topical medications to promote healing and manage discomfort. Follow-up appointments are typically scheduled to assess the healing process and address any concerns that may arise during recovery.