Our aim was to compare the efficacy and safety of autologous in-situ blood coagulum versus sutures for attaching conjunctival limbal autografts (CAG) among patients undergoing primary pterygium excision over a period of 1 year. Thirty-two eyes of 32 patients with primary pterygium were randomly divided in into two groups: group I (16 eyes) underwent CAG with 10-0 monofilament nylon sutures and group II (16 eyes) underwent CAG with patient's own in-situ blood coagulum acting as bioadhesive or fixative followed by bandaging for 48 h. Patients were followed up postoperatively on the 2nd day, 1 week, 2 weeks, 4 weeks, and 12 months. All the surgeries were done by the same surgeon. Graft success, recurrence rate, operating time, patient comfort, graft retraction or any other complication were studied. The duration of surgery was significantly less (P < 0.001) in group II (mean duration 15 ± 2 min) than group I (mean duration 67 ± 2 min). Postoperative symptoms were fewer for group II than group I. Rate of recurrence was equal in both groups (one patient in each group, 6.25 %). But complications regarding graft failure and graft retraction were more common in group II (two patients, 12.5 %) than group I (one patient, 6.25 %); however, the difference was not statistically significant (Z = 0.61). Thus, autologous in-situ blood coagulum is a useful method for graft fixation in pterygium surgery with shorter operating time and less postoperative discomfort.
Ocular surface injury causes serious vision-related problems especially when limbal stem cells are affected. Treatment lies in the transplantation of viable donor cells. Various substrates are used for the cultivation of limbal epithelial stem cells. In the present study, viability and proliferation of ex vivo cultured limbal epithelial stem cells were examined on a variety of substrates like collagen type IV, direct plastic Petri plate, intact amniotic membrane and denuded amniotic membrane. Viability and proliferation of cells were examined by colorimetric assay and [(3)H]-thymidine incorporation study. Furthermore, matrix metalloproteinase is known to be a key regulator in stem cell migration and proliferation. This enzyme activity was studied by gelatinolytic zymography. It was found from this study that although human limbal epithelial stem cells could be cultivated on different substrates such as collagen type IV, direct plastic Petri plate, intact amniotic membrane and denuded amniotic membrane, maximum growth and proliferation was observed when cultured on intact amniotic membrane. The number of patients suffering from limbal epithelial stem cell deficiency is large compared to donor tissues available for transplantation. Hence, increased cell viability and proliferation is required to serve more patients.
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