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
PURPOSE: To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium. METHODS: Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated. RESULTS: With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 +/- 6.9 minutes) was significantly shorter than that in the wide excision group (62.4 +/- 6.2 minutes). CONCLUSIONS: Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia.
Subject(s)
Humans , Eye , Fibrosis , Follow-Up Studies , Granuloma , Pterygium , Recurrence , Retention, Psychology , Tissue DonorsABSTRACT
PURPOSE: To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium. METHODS: Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively. RESULTS: With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups. CONCLUSIONS: Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.
Subject(s)
Humans , Adhesives , Amnion , Conjunctiva , Eye , Fibrin Tissue Adhesive , Follow-Up Studies , Pterygium , Recurrence , Retrospective Studies , Sutures , TransplantsABSTRACT
PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-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. RESULTS: The 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. CONCLUSIONS: The 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.