Application of platelet‐rich fibrin grafts following pterygium excision

Abstract

Pterygium, which is a fibrovascular overgrowth tissue of the conjunctiva, is a common ocular surface disorder worldwide, especially in China. 1 It is commonly triangular in shape and encroaches into the cornea, and originates from the degenerated conjunctiva and the underlying Tenon's capsule, resulting in abnormal fibrovascular tissue proliferation. 2 Many risk factors, such as sunny, hot, dry, windy, dusty climate, and smoky and tropical regions, are related to the pterygium. 1,2 Ultraviolet radiation is a major factor, that damages cell proliferation and induces abnormal cell proliferation, goblet cell hyperplasia, squamous metaplasia fibrosis, inflammation, angiogenesis and extracellular matrix breakdown. 3 The pathogenesis of pterygium still needs to be elucidated and deeply studied. To date, many surgical treatments have been performed on the pterygium including primary conjunctival closure, conjunctival autografts (CAs), limbal conjunctival autografts (LCAs), leaving bare sclera and amniotic membrane transplantation (AMT). [3][4][5] The main postoperative complication is recurrence; therefore, every effort should be directed in reducing the recurrence rate. However, no gold standard treatment for surgical procedures to completely prevent recurrence has been confirmed.

Use of Cryopreserved Amniotic Membrane During Pterygium Excision: Health Economic Analysis

“… 10 , 13 , 26 , 27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. 10 , 12 , 13 , 17 , 18 , 24 , 27 Aside from one study that reported the use of autologous fibrin glue, 20 the fibrin glues used in the studies were commercially available products such as Tisseel ® (Baxter Healthcare Corporation, Glendale, CA) and FIBINGLURAAS ® (Shanghai RAAS Blood Products Co., Ltd, China). In the majority of the studies assessing CAU with sutures, the graft was anchored to the episclera and attached to the adjacent conjunctiva with interrupted 8–0 Vicryl sutures or 10–0 nylon sutures.…”

“…All studies were randomized controlled trials aside from four prospective comparative studies. [10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,[14][15][16][17][18][19][20] six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus.…”

“…[10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,[14][15][16][17][18][19][20] six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. 10,12,13,17,18,24,27 Aside from one study that reported the use of autologous fibrin glue, 20 the fibrin glues used in the studies were commercially available products such as Tisseel ® (Baxter Healthcare Corporation, Glendale, CA) and FIBINGLURAAS ® (Shanghai RAAS Blood Products Co., Ltd, China).…”

Symblepharon, Ankyloblepharon, and Salt Gland Dysfunction in a Loggerhead Sea Turtle (Caretta caretta)

“…To prevent recurrence, which occurs in many cases after dissection of conjunctival adhesions and superficial keratectomy, the application of temporary implants such as amniotic membranes (AMs) [32], soft contact lenses (SCLs) [33][34][35], methyl methacrylate corneal protectors [6], gelatin sponges [36], mitomycin C [37], partial limbal stem cell implants [38,39], and platelet-rich fibrin grafts [40] has been described for the treatment of symblepharon in human and veterinary ophthalmology. When adhesions continue beyond the limbus into the conjunctiva, these too are severed [6].…”

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

“…A clinical study with 108 patients comparing the use of platelet-rich fibrin (PRF) grafts and limbal conjunctival autografts (LCA) in pterygium surgery has recently been published, and it was observed that the surgery time was shorter in the PRF group (25.0 ± 4.2 min) than in the LCA group (36.5 ± 6.3 min) ( p < 0.001) [ 64 ]. The use of mPRGF could decrease the surgical time compared to the conjunctival autograft group, since conjunctival dissection is not necessary; we believe that the surgical time would be similar to that of the amniotic membrane group.…”