ABSTRACT
Purpose: To evaluate and analyze the outcomes of sutureless and glue?free limbal?conjunctival autografting in cases of primary as well as recurrent pterygium. Methods: This prospective interventional study was carried out between February 2019 and February 2020 at a tertiary care hospital in North India. A total of 70 patients with pterygium underwent sutureless and glue?free limbal?conjunctival autograft. The patients were divided into two groups: group 1 patients with primary pterygium (n = 45), group 2 patients with recurrent pterygium (n = 25). The patients were followed up till 12 months postoperatively. Results: The mean age of the patients in group 1 and group 2 was 37.04 ± 8.69 years and 32.52 ± 6.49 years, respectively (P = 0.04). Postoperatively, no recurrence was recorded in group 1. Recurrence was noticed in two patients (8%) of group 2. The BCVA changed from 78.73 ± 9.86 letters to 80.15 ± 7.29 letters (P = 0.45) and from 79.6 ± 6.44 letters to 79.8 ± 5.86 letters (P = 0.45) in group 1 and group 2, respectively. Graft edema was found in seven (15.55%) cases of group 1 and four (16%) cases of group 2. Graft retraction was found in two (4.44%) cases of group 1 and three (12%) cases of group 2. Conclusion: Sutureless and a glue?free limbal?conjunctival autograft is a safe and effective treatment option for primary as well as recurrent pterygium.
ABSTRACT
@#AIM: To compare the outcome in terms of patients comfort, graft stability, graft inflammation, recurrence and other postoperative complications between the two sizes of conjunctivolimbal autograft used in fibrin glue and suture less glue free methods of conjunctivolimbal autograft fixation for primary pterygium surgery.<p>METHODS: This was a prospective interventional comparative study conducted on 80 patients(80 eyes)with pterygium from December 2014 to August 2016. The study group was randomly selected and divided into two groups, <i>i.e.</i> people underwent fibrin glue was group 1, and those underwent suture less glue free methods of autograft fixation was group 2. For each group equal numbers of subjects were enrolled and further each group was divided into two more groups(groups A and B in group 1, groups C and D in group 2)by random selection. Group A(size of autograft same as bare sclera)and group B(size 1 mm larger than bare sclera)received fibrin glue technique; and group C(size of autograft same as bare sclera)and group D(size 1 mm larger than bare sclera)received suture less glue free technique of conjunctival autograft fixation. Each patient underwent pterygium excision with size of conjunctival autograft used as per the respective group. Follow up visits were scheduled at 1d, 1wk, 6wk, 6mo and 1y postoperatively.<p>RESULTS: Mean age of the patients in group 1(Fibrin glue group)was 43.525 years old and in group 2(suture less glue free group)was 42.2 years old. Females were 60 and males were 20. All the 37 patients had pterygium in RE. Average surgical time was similar in all the four groups. Postoperative parameters like patient comfort, graft retraction, graft inflammation and graft edema were similar in all the four groups during every postoperative follow-up visits except for subconjunctival haemorrhage which was significantly more in fibrin glue group until first postoperative week(<i>P</i><0.0001). Grade 4 graft retraction/displacement was observed in only three patients from group 2. At 1wk postoperative, graft cyst was observed in two patients(one in group A and one in group D). Recurrence was observed in two patients(in group D)at 6mo follow-up.<p>CONCLUSION: Both methods are safe and effective for graft adhesion with less postoperative discomfort and complications. Compared to fibrin glue method, suture less and glue free method is very economical and outcome in this method is comparable to fibrin glue group. Since this procedure is cost effective and also have all the advantages of fibrin glue, suture less glue free method can be considered as very effective method in treating patients.
ABSTRACT
A prospective interventional self-control study to analyse the profile and outcome of suture less and glue free limbal conjunctival autograft for the management of primary pterygium was carried out in 80 eyes with primary nasal pterygium requiring surgical excision. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the eyes followed by bandaging for 24 hours. The patients were followed up post operatively after 24 hrs., on 3rd day, after 1, 3, 6 weeks and at 3 months. They were examined for visual acuity, hemorrhage, wound gape, graft retraction, graft edema, recurrence or any other complication among the study population. The mean age of the patients was 40.78 years (range 19-80), 56.25% of which were females. Graft retraction occurred in 3 eyes (3.75%) and recurrence was seen in 1 eye (1.25%). Hemorrhage was seen in 26 (32.5%) eyes at 24 hours, which persisted in only 06(7.5%) eyes at 3 weeks and resolved completely in 100% of eyes at 6 weeks. Edema was also noted in 4 (5%) eyes, persisted only in 1(1.25%) eye at 3rd day and resolved completely by 1 week. At 6 weeks postoperatively, three (3.75%) eyes showed gain in best corrected visual acuity by one line and one (1.25%) eye by three lines on snellen's drum. No other complication was noted. Suture less and glue free limbal conjunctival autografting following pterygium excision is an effective and safe option for the management of primary pterygium.