A Comparative Study of Conjunctival-Limbal Autograft with Fibrin Clot and Glue Techniques for Pterygium

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Introduction: Pterygium is a common conjunctival disorder seen in tropical countries. Surgery is the permanent treatment. Various methods of graft fixation include sutures, fibrin clot, and glue techniques. Fibrin clot (autologous serum) technique involves the utilization of the patient's oozed blood from the episcleral vessels to serve as natural glue adhering the graft to the underlying sclera, whereas commercial glue involves the use of two components for firm adherence of the graft. Aim: The aim of this study is to observe and compare the complication rates, outcomes, and recurrence with fibrin clot and glue techniques for pterygium. Materials and Methods: One hundred and twenty-six eyes of 126 patients with primary pterygium were operated under peribulbar anesthesia by a single surgeon after doing the routine clinical examination. Group A included 63 eyes where the fibrin clot technique was used for graft adherence and Group B included 63 eyes where commercial glue was used for fixing the graft. Pterygium was excised, and a conjunctival-limbal autograft was taken from the superior bulbar conjunctiva of the same eye. In the fibrin clot (autologous serum) technique, natural hemostasis was encouraged, and the graft was placed over the oozed blood, left undisturbed for 10 min. In the glue technique, hemostasis was achieved and graft was transplanted over the glue and left undisturbed for 2 min. Eye patch was removed the next day of surgery. Preoperative and postoperative photographs were taken. Standard postoperative treatment was given. Follow-up was carried on day (postoperative day) 1, 15, 30, 90, 180, and 300. Results: The mean surgical time was 29.3 and 19.6 min in Group A and Group B, respectively. Graft retraction and graft edema were noted in four patients (6.3%) in fibrin clot technique, and graft edema was noted in five patients (7.9%) in Group B, which resolved on subsequent visits with conservative management. No recurrence was noted in either group. No other postoperative complications were noted in both groups. Conclusion: Fibrin clot (autologous serum) and glue techniques do not use sutures, thus avoid the cost of sutures and suture-related discomfort and complications. Fibrin clot (autologous serum) is more economical than the glue technique. Cosmetic outcome in the immediate postoperative period is better with glue than fibrin clot technique. Long-term outcome is the same in both groups. Autologous serum avoids the transmission of prion diseases possible with glue method. Both the techniques are equally safe and efficient.