Abstract
Aim: To compare surgical outcomes of pterygium excision with conjunctival autograft using Sutures and Autologous blood for primary pterygium. Materials and methods: Retrospective study done in 404 eyes with primary pterygium. Excision of the pterygium and conjunctival autograft fixation using sutures (group 1) or Autologous blood (group 2). Graft related complications such as recurrence, graft loss, graft retraction, granuloma were noted and compared between the two groups. Result: The average time taken for surgery was 10.66 ± 0.89 (group 1) and 10.44 ± 0.77 (group 2) (p=0.009). The recurrence rate following pterygium surgery was noted in 5eyes (2.5%) in group 1, and 10 eyes (4.9%) in group 2. Graft retraction was seen in 13 eyes in group 1,57 eyes in group 2, of the eyes with graft retraction only 2 eyes in group 1, and 7 eyes in group 2 developed recurrence (p=0.763). Graft loss was seen in 3eyes (1.49%) and in 7eyes (3.44%) in group 2, all patients who developed graft loss developed graft recurrence. Granuloma formation was seen in 2 eyes (0.99%) in group 1 and in 1eye (0.49%) in group 2. The cost of pterygium surgery using glue and autologous blood for conjunctival autograft fixation is much less than procuring and using fibrin glue. Conclusion: Fixing of graft and suturing it in place is important to prevent recurrence. Duration of surgical procedure is comparable. Recurrence and retraction rates are slightly higher in autologous blood group, but not statistically significant. Hence both sutures and autologous blood are very good treatment options for our patients with primary pterygium.
Highlights
Pterygium is a fleshy fibrovascular growth of conjunctiva arising from subconjunctival tissue with extension on cornea and this extension may vary from patient to patient
[28] The prevalence of pterygium in South Indian population is 9.5%. [29] A number of surgical techniques have been described as methods for management of pterygium, including bare sclera resection, bare sclera resection followed by mitomycin C application at different point of time, doses, and concentrations and pterygium excision plus conjunctival autografting or amniotic membrane placement. [3,4,5] Conjunctival autografting has been advocated for the management of recurrent pterygium
Medical records of patients who underwent pterygium excision with conjunctival autografting between january 2011 and december 2016 were reviewed. 201 eyes of 194 patients [group 1] underwent pterygium excision with conjunctival autograft fixation using 10-0 monofilament nylon (Ethilon, Johnson & Johnson) and 203 eyes of 183 patients autologous blood [group 2] was used to fix the conjunctival autograft
Summary
Pterygium is a fleshy fibrovascular growth of conjunctiva arising from subconjunctival tissue with extension on cornea and this extension may vary from patient to patient. A small pterygium causes only slight irritation, cosmetic blemish, and slight heaviness or redness in the eyes but with progression it can cause impairment of vision. Once it invades the cornea, it causes corneal opacity. This study of ours was done to compare the outcomes of the 2 well known surgical techniques of graft fixation i.e using sutures and the suture-less, glue free graft fixation using autologous blood for pterygium surgery. We hope that this study would add to the growing knowledge and cost-effective management of pterygium surgery
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