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

Abstract

Aims Foreign materials used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Methods After pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is tamponaded. Graft adherence and positioning is examined 20 min after surgery. Results A total of 15 eyes of 12 patients (mean (SD) age 73.7 (11.2) years), 8 females underwent SGF autologous conjunctival graft post-pterygium excision. Mean graft area was 24(1.5) mm 2 . Mean follow-up time was 9.2 (2.2) months. Cosmesis was excellent in all cases and visual acuity improved in one patient. There were no intra-or post-operative complications requiring further treatment. Conclusion This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and in this small series provided safe and comparable results to current methods.

Comparison of pre-operative and post-operative astigmatism and visual acuity after pterygium excision followed by sutureless and gluefree conjunctival autograft

“…The recurrence rate was very low i.e. 1.92 % attributed to sutureless and gluefree conjunctival autograft due to which sutures and fibrin glue related complications are bypassed [14,[28][29][30].…”

“…Apart from reduction of astigmatism and visual acuity improvement we should also consider such technique which have lowest recurrence rate. Pterygium excision followed by sutureless and gluefree conjunctival autograft can be considered as a better technique to reduce astigmatism, improvement in visual acuity with additional benefit of low recurrence rate [14], in comparison to other techniques [15][16][17][18].…”

Conjunctival limbal autograft transplantation in pterygium surgery by natural haemostasis

“…Other complication like pyogenic granuloma, symblepharon, forniceal contracture, ocular motility restriction, diplopia, scleral necrosis are very difficult to manage. 5 The advantages of using fibrin glue for attaching graft include ease of use, shorter operating time and less postoperative discomfort. Moreover, conjunctival limbal autograft will be better accepted by the patient, because the use of fibrin glue produces less subjective symptoms.…”

“…Recent report favour the use of fibrin glue above sutures with improved comfort, decreased surgical time, reduced complication of recurrence rates. 5 Conventional suturing causes complications like foreign body reaction, infection, scarring in maximum no of patients. 5 Their application is slow and needs skill.…”

“…5 Conventional suturing causes complications like foreign body reaction, infection, scarring in maximum no of patients. 5 Their application is slow and needs skill. In the search of solution of these problems, concept of tissue adhesive was floated.…”