ASCRS 2026: Marguerite B. McDonald, MD, FACS, on glueless, sutureless pterygium surgery outcomes

A retrospective approach using decellularized basement membrane (BIOVANCE 3L Ocular; DefEYE Inc.) without sutures or glue was presented by Marguerite B. McDonald, MD, FACS, as an alternative technique for pterygium management, with emphasis on efficiency, tissue preservation, and postoperative recovery at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting, held April 10 to 13 in Washington, DC.

McDonald, who is in practice at OCLI Vision in Long Island, New York, described her search “for a better way to do pterygium surgery,” noting limitations of the traditional conjunctival autograft approach, including operative time, tissue use, and recovery profile. The standard technique “takes a lot of time in the OR,” involves suturing, and “you’re using up a lot of conjunctival real estate that might be needed later for glaucoma surgery.” She also highlighted patient-centered drawbacks such as “pain, relatively slow recovery of vision, and the eye stays quite red for many weeks.”

In contrast, her retrospective analysis of a glueless, sutureless technique using a triple-layer decellularized basement membrane demonstrated a streamlined surgical course. “We were not using up any conjunctival tissue at all. No [conjunctival] autograft, no sutures, no glue,” she said. Operative efficiency improved, with “a shorter time in the OR,” and postoperative recovery appeared faster, with patients recovering “so much faster” and experiencing quiet eyes early in the course.

A key observation was the reported absence of recurrence during follow-up. “For the first time ever, there was a zero recurrence rate,” she said, noting that patients were followed for extended periods and that “we all know recurrences occur very quickly.” This finding applied to both primary and secondary cases, including more challenging recurrent pterygia, where “the recurrence rate is extraordinarily high,” yet “we had none.”

Postoperative management was also simplified. Patients required only “a rapid one-month taper, and often only two weeks” of steroids, and comfort levels were high, with “virtually no need for a narcotic of any kind.” The technique relies on biologic properties of the membrane, which “delivered healing factors that sped the return of vision, corneal healing, conjunctival healing.”

From a technical standpoint, McDonald emphasized careful tissue handling. Surgeons should avoid excessive cautery, as “to leave the bed vascularized is an important thing.” The membrane disc is positioned partly over the cornea and partly under adjacent conjunctiva; “it just sticks like fly paper,” eliminating the need for fixation. A bandage contact lens is applied, and residual membrane fragments can be left in place, as “the longer it stayed there, the more goodies it would dump onto the ocular surface.”

Overall, the approach was described as “a win-win-win,” combining surgical efficiency, reduced tissue disruption, and favorable recovery characteristics.