Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

Abstract

PurposeTo evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium.MethodsThirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations.ResultsThe mean patient age was 57.9±10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05±5.78 weeks. The mean surgery time was 18.04±5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive.ConclusionsThe use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms. Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series

“…19 Most importantly however, the operating time, post-operative symptoms, recurrence, and complication rate of the above-described technique (SGF) in our series appears to be equivalent to conventional suture and glue techniques of a similar follow-up duration. 3,4,6,10 Specifically, the risk of graft retraction as described by Tan 7 appears to be no greater without suturing or fibrin glue as long as meticulous dissection of the subepithelial graft tissue is respected. We postulate that as there is an even tension across the whole of the graft interface and no direct tension on the free graft edges, there is reduced stimulus for subconjunctival scar tissue to form.…”

“…Recent reports favour the use of fibrin glue [2][3][4][5] above sutures with improved comfort, decreased surgical time, reduced complication and recurrence rates have been reported. Suture-related complications include infection, granuloma formation, and chronic inflammation, 6,7 whereas plasma-derived fibrin glue has the potential risk of prion disease transmission and anaphylaxis in susceptible individuals.…”

Conjunctival Autograft With Autologous Blood Coagulum in Primary and Recurrent Pterygium- An Observational Study

“…Kim et al reported that patient's symptoms disappeared in 23 out of 36 eyes (64%) in one week and all the symptoms gone within two weeks after surgery in all patients. [16] Graft oedema was noticed in 78% of patients at day one, which gradually reduced to 4% at the end of 3 months and with short course of topical steroids oedema fully resolved at the end of 6 months in all patients [ Figure 4a]. A study from Philippines reported that postoperatively some amount of graft oedema was present in all eyes and it gradually subsided overtime.…”

New Limboconjunctival Flap Technique in the Surgical Treatment of Primary Pterygium: A Preliminary Report

“…Relapse rates in pterygium following limbal stem cell or limboconjunctival tissue transplantation vary between 0% and 14.6% (23)(24)(25)(26)(27). Conjunctival autograph relapse rates vary between 0% and 33.3% in the literature (11-14, 28, 29).…”