Fibrin Glue Versus Autologous Serum for Conjunctival Autograft Fixation in Pterygium Surgery

Abstract

Purpose: To compare the outcomes of conjunctival autograft fixation using autologous serum vs fibrin glue to cover the bare sclera in pterygium excision surgery.
 Study Design: Quasi experimental study.
 Place and Duration of Study: The study was conducted in Ophthalmology Department of CMH Kharian from April 2018 to November 2018.
 Material and Methods: Forty patients with primary pterygium were selected by convenient sampling technique. Patients with recurrent Pterygia and moderate to severe dry eyes, keratitis or secondary to trauma were excluded. The patients were divided into two groups, group A treated with fibrin glue and group B treated with autologous serum technique. All patients underwent pterygium excision under topical anaesthesia. The conjunctival autograft was removed from superior temporal bulbar conjunctiva to cover the scleral bed produced by pterygium excision. Post operatively the patients were followed-up for three months to assess the fixation or otherwise. Data was noted and analysed by using SPSS version 23.
 Results: The graft was taken-up nicely in most of the cases. The patients were followed up for three months after surgery. The frequency of graft lost in Group A and Group B was noted as n = 8 (40%) and n = 1 (5%), respectively (p = 0.008). The only other complication was recurrence of pterygium which was n = 5 (25%) and n = 3 (15%), in Group A and Group B, respectively (p = 0.429). No case of infection was noted.
 Conclusion: Fixation of conjunctival autograft with autologous serum is a safe and effective method and potential alternative of fibrin glue technique.

Pterygium excision with rotational conjunctival flap - a simple and effective method

“…The recurrence rate in our patients (8%) is comparable to that of CAG andAMT. [4][5][6] The rate of significant post-operative flap edemain our study (5.5%), was lesser than that reported by Shakil et al (16.6%) probably because the pedicle size of our flap was larger compared to anchored RCF,ensuring better flap vascularity and stability, and preventing significant reperfusion injury. Re-perfusion injury is more common in free flap or graft than pedicled flap as restoration of blood supply to the former takes more time.…”

“…19 Studies done in our population show recurrence rate following CAG, AMT and conjunctival flap varying from 3.3% to 25%, 7.84% to 10% and 6.6% to 9.76% respectively. [4][5][6]22,23 Shakil et al used anchored conjunctival flap technique in which flap was anchored at 1mm frill of limbal conjunctiva and secured at scleral bed with 7/0 polyglactin (vicryl) sutures. The author found this method resulting in lesser postoperative edema and similar recurrence rates compared to CAG, 22 while Akhter et al reported shorter surgical time with flap compared to CAG.…”

“…1,3 Multiple studies have been done in Pakistan showing efficacy of different surgical procedures and adjunctive therapies. [4][5][6][7] However, data regarding rotational conjunctival flap (RCF) procedure in our population is scarce. Hence, this study was conducted to investigate effectiveness of RCF procedure with regard to intra/postoperative complications and recurrence rate in our locality.…”

Autologous Serum for Fixation of Limbal Conjunctival Autograft in Primary Pterygium Surgery

“…It was noted in eight eyes (40%) in group A treated with fibrin glue and one eye (5%) in group B treated with autologous serum. 13 It has been known that thick grafts not covering the limbus may increase the risk of recurrence. 14 Sabahattin Sul et al, used autologous serum drops in pterygium surgery.…”