Is Suturless and Gluelesslimbal Conjunctival Autograft for Primary Pterygium Surgery Efficient and Safe ?

Abstract

Aim of the study:evaluate the safety and efficacy of sutureless glue free limbal conjunctival autograft for the management of primary pterygium surgery. Material and method:This prospective,interventional randomized,non comparative study was held at AlZahraaUniversity Hospital between May, 2013 and June, 2015. It included 20 eyes of 17 patients, 12 males(70.6%), and 5 females(29.4%). Their mean age±SD was 52.50±18.31 years (Range:30-75 years). They were presented to the outpatient clinic of Al Zahraa University Hospital with primary pterygium. Inclusion criteria included primary pterygium,non atrophic, with healthy conjunctiva. Exclusion criteria included atrophic pterygium, pseudopterygium, ocular surface pathology, infection, previous limbal surgery or double head pterygium. Surgeries were done under local anesthesia. Simple pterygium excision was done leaving a bare sclera. The size of bare sclera was measured. A conjunctival graft 2 mm larger in width and length than the recipient bed was created from the superior temporal quadrantand was extended to the limbus to include limbal stem cells. The graft was gently moved to the recipient bed with the epithelial side up and keeping the limbal edge toward the limbus.Hemostasis was allowed to occur spontaneously without use of cautery to provide autologous fibrin to glue the conjunctival autograft naturally in position without tension.All patients were followed up after 48 hours, weekly for one month then monthly for 12 months. Results:Pterygia were located nasally in all cases. Pterygia were presented right eye in10(50%) and left eye 10(50%). Mean graft size±SD was 5.5±1.5 millimeter (Range: 5-7 mm). Mean duration of graft fixation ±SD was 10±2.82 minutes (Range:10–12minutes).Mean operative time±SD was 25±1.41 minutes(Range: 24-26 minutes) with good cosmetic outcome in all cases. There was minimal postoperative pain and discomfort, without graft dislocation or dehiscence and without recurrence of pterygia during the follow up period. Conclusion:Sutureless and gluelessconjunctivallimbalautograft following primary pterygium excision is safe,easy,effective and economic technique in primary pterygium surgery.