The influence of pterygium morphology on fibrin glue conjunctival autografting pterygium surgery

Abstract

To evaluate the influence of pterygium morphology on the efficacy and safety of fibrin glue in pterygium surgery with conjunctival autografting. A prospective case series. During a period of 15 months, 45 patients (51 eyes) were recruited from the General Hospital for pterygium surgery. Seven eyes (13.73 %) were operated on for a recurrent pterygium. Autologous conjunctiva was harvested from the superior bulbar conjunctiva and fixed with fibrin glue. The pterygia were preoperatively divided into atrophic/grade 1 (n = 18; 35.29 %), intermediate/grade 2 (n = 22; 43.14 %) or fleshy/grade 3 (n = 11; 21.57 %) according to clinical morphology. Patients were evaluated for intraoperative and postoperative complications and recurrence rates. The success rate was defined by no pterygium recurrences. Patients with 2-year follow-ups were included in this study. Fifty-one patients (21 females/30 males) with a mean age of 60-65 years (range 24-87 years) took part in the study. All patients completed the study. No intraoperative complications were noted. Postsurgical complications included graft edema (n = 4; 7.8 %), graft hyperemia (n = 2; 3.8 %), and graft dislocation (n = 3; 5.9 %); these complications were transient. One graft unfastened completely (2 %) and five pterygium recurrences occurred (n = 5; 9.8 %). The overall success rate was 90 % after 2 years. In grade I group there were no recurrences, in grade 2 group there were two recurrences, and in grade 3 group there were three recurrences. There were significantly more recurrences in grade 3 group than in grade 2 group. There were more recurrences in both groups than in group 1 (60 vs 40 vs 0 % of all recurrences, p ≤ 0.05). The use of fibrin glue is a safe, easy and effective technique for attaching the conjunctival autograft in pterygium surgery. The morphology of pterygium influences recurrence rates, without significance for intraoperative and postoperative complications.

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“…From previous literature, it is understood that pterygium size and grade increases the risk of recurrence [25][26][27]. In our cases, it cannot be determined if attendings selected the more complex and higher grade cases.…”

Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis

“…Finally, the follow-up duration in some studies included in the present review might not have been sufficient. Reports showed that 50% of recurrences might occur with in 4 months, and 97% might occur within 12 months [ 62 , 63 ]. Thus, follow-up of at least 1 year is appropriate.…”

The Use of Fibrin Glue in Primary and Recurrent Pterygium Surgery

“…Sandra et al reported that the use of fibrin glue was a safe, easy and effective technique for attaching the conjunctival autograft in pterygium surgery and the morphology of pterygium influenced recurrence rates, without significant intraoperative and postoperative complications. 22 Shehadeh-Mashor et al reported that pterygium excision and conjunctival autograft using fibrin glue to secure the graft combined with intraoperative mitomycine C seems to be a safe and effective surgical option for treating recurrent pterygium. 23 When the two components of the fibrin glue are applied simultaneously, a fibrin clot forms within approximately 30 seconds.…”