Suture and glue-free autologous graft for pterygium surgery

Abstract

Of various techniques of pteryium surgeries to prevent recurrence, conjunctival limbal auto graft has been the most successful adjuvant since the studies have shown the role of limbal stem cell deficiency (LSCD) as pathology of pterygium. The most common method of auto-graft fixation post pterygium excision is suturing; with drawbacks of prolonged operating time and postoperative discomfort. Replacing sutures with tissue adhesives may shorten the operating time, improve postoperative comfort; however, the major concern of the commercial fibrin glue is the cost and the potential risk of transmission of infection.To study, 1. The efficacy and complications of suture free and glue free conjunctival-limbal auto-graft for the management of pterygia, 2. The outcome of surgeries by two different qualified surgeons  Prospective, interventional case study of 108 consecutive cases of pterygia that had excision with conjunctival-limbal auto-grafting without using glue or sutures. The operated eye patched for a day and followed up on day 1, 3 and 7, 6 weeks and 6 months; watched for hemorrhage beneath the graft, graft retraction, chemosis, recurrence or any other complication.  The mean age of the patients was 40.7 years (range, 25 – 68 years) with female preponderance (60.2%) and nasal pterygia in 65.7 %. Not a single graft was dislodged and none had recurrence in the follow up period of 9-20 months. Graft retraction occurred in 7 cases (6.5%) and one patient had sub-graft hemorrhage which lasted for nine days. 76.9% had no discomfort even in immediate post-operative period. The results were comparable among patients of both the surgeons.Suture- and glue-freelimbal conjunctival auto-grafting following pterygium excision is a safe, effective and economical option for the management of both primary and recurrent pterygium. Learning curve is short and consistently similar results possible in different hands.