Comparison of 4 Techniques for Limbal-Conjunctival Autograft Fixation in Primary Pterygium Surgery

Mejía, Luis Fernando; Santamaría, Juan P.; Cuevas, Miguel; Córdoba, Andrea; Carvajal, Sergio A.

doi:10.5301/ejo.5000924

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…It has been reported already that cautery autograft fixation has reduced postoperative discomfort compared with autograft fixation with sutures, fibrin glue and autologous fibrin glue. 20 Studies including autografting with electrocautery pen compared with suture autografting have showed that thermal welding can be safe and fast alternative, with less postoperative discomfort. 12 Idea of hybrid technique for joined suturing and cauterisation has been presented for large pterygia, and further usage of bipolar cautery has been proposed.…”

Section: Introductionmentioning

confidence: 99%

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

et al. 2018

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IntroductionPterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery.Methods and analysesThis will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days.Ethics and disseminationThe trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications.Trial registration numberNCT03321201; Pre-results.

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Section: Introductionmentioning

confidence: 99%

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

et al. 2018

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“…Mejia et al 10 compared four limbal-conjunctival autograft fixation techniques – conventional suture, commercial fibrin glue, autologous fibrin glue, and cautery – in primary pterygium surgery. The authors found that limbal-conjunctival autograft fixation with cautery was the technique with the lowest postoperative discomfort rate, as well as the one not having a statistically significant increase in recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

“…8 A less expensive and alternative option to fibrin glue involves conjunctival autograft fixation induced by hemostasis of the patient’s own serum and electrocauterization. 8–10…”

Section: Introductionmentioning

confidence: 99%

“…The use of electrocauterization for conjunctival autograft fixation in pterygium surgery with a monopolar electrocautery pen was first proposed by Xu et al, 9 with good results. In 2017, Mejia et al 10 retrospectively compared bipolar electrocauterization, fibrin glue, suture, and autologous serum for fixation of conjunctival limbal autograft in 169 patients with primary pterygia and found similar recurrence rates among the four groups. The present report describes our experience using a bipolar electrocauterization for conjunctival autograft fixation in pterygium surgery.…”

Section: Introductionmentioning

confidence: 99%

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Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization

Costa

Barbosa

et al. 2020

European Journal of Ophthalmology

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Purpose: To report a case series of pterygium surgery with conjunctival autograft fixation using bipolar electrocautery. Design: A noncomparative, retrospective, interventional case series of pterygium surgery with follow-up longer than 12 months to assess recurrence and other complication rates. Participants: Fifty-six eyes of 37 patients were treated between April 2011 and January 2018, either for primary ( n = 53 cases) or recurrent ( n = 3 cases) pterygia. Intervention: After pterygium excision, free conjunctival grafts from the inferior bulbar conjunctiva of the same eye were harvested and fixated with the use of bipolar electrocautery. Main outcome measure: Recurrence of the pterygium and complications. Results: The mean follow-up was 41 months (range 12 to 81 months). There were no intraoperative complications. Recurrence of the lesion was seen in three eyes (5.36%). There were no other postoperative complications such as graft detachment, or formation of dellen or granulomas. Conclusion: Conjunctival autograft fixation using bipolar electrocautery seems to be a fast, costly and safe procedure that can be applied in most cases of pterygium surgery.

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“…Common surgical techniques include simple pterygium excision, conjunctival autograft transplantation, pterygium transposition, pterygium excision combined with amniotic membrane transplantation, limbal-conjunctival autograft transplantation, and adjunctive therapies such as use of mitomycin C, anti-VEGFs, or antibrotics. [8][9][10][11]. Pterygium transposition can change the direction of pterygium growth, but it affects the facial beauty of patients.…”

Section: Introductionmentioning

confidence: 99%

Limbal-conjunctival Autograft Transplantation Versus Conjunctival Autograft Transplantation In The Treatment Of Pterygium: A Self-control Study

Wang¹,

Gu²,

Zhang³

et al. 2019

Preprint

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Background : Pterygium is a common ocular growth, which affects vision, ocular surface function, and aesthetics of the eye. Although various surgical methods are used for treating pterygium, there has been no consensus on the most suitable method. Therefore, it is important to choose the most appropriate and effective surgical method for the treatment of pterygium. The aim of this study was to compare the characteristics and efficacy of limbal-conjunctical autograft transplantation and conjunctival autograft transplantation for the treatment of pterygium. Methods : From August 2015 to December 2016, 80 patients with bilateral primary pterygium in Minhang Hospital affiliated to Fudan University were treated with limbal-conjunctival autograft transplantation in one eye (group A) and conjunctival autograft transplantation in the fellow eye (group B). The operative times of the two surgical methods were compared. The corneal epithelial healing times and recurrence rates for the two methods were observed and recorded after two years of follow-up. Results : Eight patients dropped out of the study and 72 patients participated in the final evaluation. The average operative time for group A and group B was 27.56 1.48 minutes and 26.91 1.39 minutes, respectively. There was no significant difference between the operative times for the two groups (t = 1.93, P = 0.058). The average corneal epithelial healing time for groups A and B was 2.56 0.34 days and 4.85 0.49 days, respectively (t=25.26, P < 0.001). Two years after the surgery, pterygium recurred in two eyes (2.78%) in group A and in nine eyes (14.29%) in group B. The difference between the two groups was statistically significant (2=4.82, P=0.028). Conclusion : In primary pterygium surgery, the healing time of the corneal epithelium after limbal-conjunctival autograft transplantation is shorter than that after conjunctival autograft transplantation, and the pterygium recurrence rate after limbal-conjunctival autograft transplantation is lower than that after autologous conjunctival transplantation. Although both limbal-conjunctival autograft transplantation and conjunctival autograft transplantation can achieve good clinical results, limbal-conjunctival autograft transplantation is superior to conjunctival autograft transplantation in terms of the corneal epithelial healing time and recurrence rate of pterygium after surgery.

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Comparison of 4 Techniques for Limbal-Conjunctival Autograft Fixation in Primary Pterygium Surgery

Abstract: In primary nasal pterygium surgery, limbal-conjunctival autograft fixation using cautery is the technique with the lowest postoperative discomfort rate and without a statistically significant increase in recurrence rate when compared to conventional suture and fibrin glue techniques.

Cited by 13 publications

References 24 publications

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization

Limbal-conjunctival Autograft Transplantation Versus Conjunctival Autograft Transplantation In The Treatment Of Pterygium: A Self-control Study

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