Autograft In Pterygium Surgery Research Articles

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note.

To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation. Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability. Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min vs 18.15±2.20min, P=0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) vs 3.00min (2.21-4.15), P<0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (P<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) vs 2 (1-4), P<0.001]. Postoperative symptoms at 6mo were comparable between the groups (P=0.487), with no recurrence. ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.

Comparison of Keratometric Change Following Various Conjunctival Autografting Techniques in Pterygium Surgery.

Aim To compare the postoperative keratometric changes and duration of surgery for different techniques of conjunctival autografting in pterygium surgery. Methods Patients with primary pterygium attending the outpatient department and having appropriate indications for surgery were enrolled. Preoperative ophthalmic examination included visual acuity assessment, refraction, keratometry, slit lamp, and fundus evaluation. Pterygium excision surgery with conjunctival autografting was performed on all patients using one of the four different techniques, namely, sutures, fibrin glue, and the autologous bloodand bridge techniques. Duration of surgery was recorded for all patients. Postoperatively, all patients were followed up on Day 1, Day 7, and Months 1, 3, and 6. Duration of surgery, keratometric changes, and recurrence rates were analyzed in all four groups. Results Sixty-eight eyes of 66 patients completed the study protocol. There was a significant reduction in astigmatism after the autologous blood graft technique (P value 0.0055) and the glue technique (P value < 0.0001). The success rate of the autologous and glue technique was 90%. The glue technique was found to be more time efficient (mean duration 20.40 minutes) than other techniques. Conclusion After pterygium excision, conjunctival auto grafting using either autologous blood or glue plays a significant role in reducing pterygium-induced astigmatism and recurrence rates with the added advantage of a shorter operative time.

Analysis of the thickness of conjunctival autograft in pterygium surgery with the Moscovici dissection technique compared with manual dissection

Analysis of the thickness of conjunctival autograft in pterygium surgery with the Moscovici dissection technique compared with manual dissection

Sutureless and Glue Free Conjunctival Autograft in Pterygium Surgery

Objective: The objective of the study is to report a newer technique of pterygium excision followed by suture less and glue free conjunctival autograft for its complications and recurrence rate. &#x0D; METHODS: This prospective and quassi experimental study was carried out at Baqai medical university hospital, Karachi from January 2016 to December 2016. This study consists of 30 eyes of 22 patients, above 15 years of age with primary progressive Pterygium of 2 mm or more in size and interfering with the vision. All the patients were operated under sub tenon’s anesthesia, Pterygium was excised with surgical blade followed by suture less and glue free conjunctival autograft from superior limbus. Primary outcomes measures included graft loss, granuloma and any other complications noted within six months. Recurrence was also noted at 6 months.&#x0D; RESULTS: There were 30 eyes of 22 patients. There were 4 females (18.18%) and 18 male patients (81.81%). The mean age was 31.28 years ± 9.4 SD. Right eye was seen in 16 (53%) cases. Graft lost was recorded in 1 patient (4.5%), conjunctival pyogenic granuloma in 1 patient (4.5%) and graft retraction was seen in 1 (4.5%) case. Recurrence rate was none at 6 months post operatively.&#x0D; CONCLUSION: Conjunctival autograft without suture and glue is a new and simple technique that can be done with minimal expenses and limited resources. It has fewer complications and no recurrence.

Α Novel Sutureless Pterygium Excision Surgery Using Human-Derived Dehydrated Amniotic Membrane

There are many surgical techniques available for the management of pterygium. Excision with limbal conjunctival autograft is currently the most popular surgical procedure and has been shown to have low recurrence rate and fewer complications. The fixation of limbal conjunctival autograft is performed with either sutures or fibrin glue. The use of sutures results in longer operating time and intense postoperative irritation and epiphora. We describe a new technique for pterygium excision using a human amniotic membrane-derived dry matrix (Omnigen®; Nottingham, UK: Nu-Vision Biotherapies). The use of Omnigen instead of conjunctival autograft in pterygium surgery is a new promising technique and results in shorter operation time, easier graft fixation, reduction in complications, and less postoperative discomfort. This is a simple technique for pterygium surgery with dry amniotic membrane matrix and without the need for anchoring limbal sutures or an assistant holding the graft whilst it is glued in place.

Evaluation of Sutureless Glueless Conjunctival Autograft in Pterygium Surgery

Evaluation of Sutureless Glueless Conjunctival Autograft in Pterygium Surgery

Хирургия птеригиума с использованием конъюнктивального аутотрансплантата

Surgery is the only effective treatment for pterygium. The most common technique is the use of a conjunctival autograft after excision of the pterygium. However, the frequency of recurrences of this method, as well as possible complications in different sources, are different. Purpose. To evaluate the efficacy, safety and recurrence rate of conjunctival autograft after pterygium excision. Material and methods. 101 patients with pterygium. aged 57.31 ± 14.7 years. The follow-up period was 1 year in 56 patients and 2 years in 45 patients. All patients underwent excision of the pterygium with conjunctival autograft. Results. An intraoperative complication can be attributed to the insufficient area of the autoconjunctival graft during its transfer to the sclera, which occurred in three patients. Postoperative complications: graft edema in 14 cases (13.86%), granuloma in the suture area was observed in 1 case (0.99%). Recurrence of pterygium was noted in only three cases (2.97%). Conclusion. The use of a conjunctival autograft in pterygium surgery has shown its effectiveness and safety, as well as a low recurrence rate. The donor zone in the upper and lateral makes it possible to excise a sufficient area of autoconjunctival graft with preservation of the intact area of possible future surgery for glaucoma. Key words: conjunctival autograft, pterygium, recurrence of pterygium.

Comparison of efficacy of conjunctival autografts using sutures and fibrin glue in patients undergoing pterygium excision surgery

Background: Pterygium is a wing-shaped ocular surface lesion traditionally described as an encroachment of bulbar conjunctiva onto the cornea. Hence; the present study was undertaken for comparing the efficacy of conjunctival autografts using sutures and fibrin glue in patients undergoing pterygium excision surgery. Materials & Methods: 40 patients presenting with the pterygia of various types were enrolled. Patients were divided into 2 groups with 20 patients in each group, for applying sutures and fibrin glue to one group each. Each eye of the patient was considered as one case. Screening of the patient by brief history and general physical examination was done. Diffuse torch light examination for details of the pterygium and to rule out any other gross ocular pathology. Follow-up was done and postoperative findings were compared. Results: Mean duration of surgery of the suture group and the glue group were 31.5 minutes and 18.4 minutes respectively. Significant results were obtained while comparing the mean duration of surgery. Patient discomfort was significantly less in the glue group in comparison to the suture group. Conclusion: From the above results, the authors concluded that the use of fibrin glue to attach the free conjunctival autograft in pterygium surgery produces shorter operating time and less post-operative discomfort as compared to sutures.

English

BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - &lt; 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - &gt; 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue

Fibrin glue versus suture for conjunctival autografting in pterygium surgery - A prospective comparative study

Fibrin glue versus suture for conjunctival autografting in pterygium surgery - A prospective comparative study

A comparative study of graft stability, complication profiles and patient comfort among sutureless glue-free and sutured conjunctivo limbal autograft in pterygium surgery of Western Rajasthan

Pterygium is a triangular encroachment of bulbar conjunctiva on to the cornea known for high recurrence rate. Various adjunctive measures were used to reduce the recurrence rate. Nowadays thoughutureless and glue-free conjunctival autograft has been encouraged for treating primary pterygium yet sutured conjunctival autograft is also extensively performed. To assess and compare graft stability, complication profiles and patient comfort in sutureless glue-free and sutured conjunctivo limbal autograft in pterygium surgery and to assess postoperative improvement in parameters associated with visual defects due to pterygium.Sutured conjunctival autograft were done in 25 patients (group A), and sutureless and glue-free conjunctival autograft was done in 25 patients (group B). Postoperative discomfort was assessed for 90 days during which graft related complications and recurrence if any were noted. Pre and postoperative parameters associated with visual defects due to pterygium were also compared. Total number of patients who developed postoperative complications was 22(88%) in Group A and 15(60%) patients in Group B. Number of patients with postoperative discomfort was significantly less in group B after 1 week and almost nil on 30 day. In Group A one patient graft unstability and in Group B two patients showed graft unstability.Sutureless glue free auto conjunctivo limbal stem cell transplantation showed significantly better patients comfort and decreases suture related complications.

Sutureless and Glue-free Conjunctival Autograft in Pterygium Surgery: A Case Series

Foreign materials used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the patients followed by bandaging for 24 hours. The patients were followed up post operatively on 2nd day, 1 week, 1 month, 3 month and 6 months. They were examined for haemorrhage, wound gape, graft shrinkage, chemosis, graft dehiscence, recurrence or any other complications. Total 100 cases were included in this case series. Patient age in ranged from 23 to 78 years (mean 50. 08 ± 12.76 years). Surgical Time was (in Minutes) from 20-28; mean &amp; SD 23.76 ± 1.89. Total graft dehiscence occurred in 1 eye (1%), graft retraction in 12 eyes (12%) and recurrence was seen in 1 eye (1%). At 3 month postoperatively, the gain in uncorrected visual acuity ranged from 2-3 line in Snellen chart in 13 eyes. No other complication was noted. This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and in this case series provided safe and comparable results to current methods.&#x0D; TAJ 2019; 32(2): 56-61

Efficacy of autologous fibrin glue versus sutures for conjunctival autograft in pterygium surgery: A 1-year randomized controlled study

Background and Aim: In recent times, the use of fibrin glue has reduced operating time and postoperative complications associated with sutures. Since it is a plasma-derived product, it has few drawbacks. The objective was to compare the efficacy, postoperative complications, and operating time of autologous fibrin glue and sutures for attaching conjunctival autografts in pterygium surgery. Materials and Methods: A total of 44 patients with primary pterygia were selected and divided in two groups: Group 1 (n = 22) underwent conjunctival autograft placement with autologous fibrin glue, whereas Group 2 (n = 22) patients underwent conjunctival autograft placement with sutures after pterygium excision. Patient demographics, history, and ocular examinations were noted; they were followed-up and examined after surgery until 3 months. Primary outcomes were postoperative pain, foreign body sensation, lacrimation, discomfort, graft retraction, graft displacement, subgraft hemorrhage, and recurrence rate. Secondary outcomes included intra- and post-operative complications. SPSS 16 was used to analyze the data. Results: The mean operative time was significantly less in Group 1 compared to Group 2 (22.1 ± 5.43 vs. 25.2 ± 2.61 min;P= 0.004). The intensity of postoperative pain was significantly lower in the group 1 than in the group 2 on postoperative day 1 and after 1st week (P

A Study on Sutureless and Glue-free Conjunctival Autograft in Pterygium Surgery in A Tertiary Medical College Hospital

Background: Foreign material used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce hypersensivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures.&#x0D; Materials &amp; Methods: This study was conducted at Jahurul Islam Medical college Hospital, Bajitpur, Kishoregonj from August 2016 to April 2018. Fifty cases with unilateral primary pterygium were selected for the study. The operation was done under local anaesthesia. After pterygium excision and fashioning of the autologus conjunctival graft, the recipient bed is allowed to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is temponaded. Graft adherence and positioning is examined after surgery.&#x0D; Results: A total of 50 eyes of 50 patients mean age at the time of surgery was 40.5±10.3 years ranged from 17 to 70 years, with a female to male ratio was 1:1.94, underwent sutureless glue-free autologus conjuntival graft after pterygium excision. Mean graft area was 24(1.5) mm2. The patients were followed up for 4 months. Cosmesis was excellent in all cases and there were no intra- or post-operative complications requiring further treatment.&#x0D; Conclusion: This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and this small series provided safe and comparable results to current methods.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 28-31

PTERYGIUM;

Objectives: To compare graft stability, patient discomfort and surgical time between autologus blood and sutures for autologus conjunctival graft adherence in pterygium surgery. Study Design: Prospective interventional study. Setting: Department of Ophthalmology, Pak Red Crescent Medical and Dental College, Dina Nath. Period: January 2017 to December 2017. Materials and Methods: Fifty eyes of fifty patients requiring pterygium surgery were enrolled. The patients were divided in two groups (A and B). Under peribulbar anesthesia pterygium was excised in all patients. Bare sclera was covered with conjuctival autograft using autologus blood as adhesive agentin Group A while in Group B conjuctival autograft was fixed with 10/0 Nylon sutures. The patients were examined postoperatively on day 1, day 7, day 14 and day 30. The groups were compared in terms of surgical time, graft displacement and patient discomfort. Results: Mean surgical time was (20.96 ±2.05 minutes) in Group A and (30.04±3.38 minutes) in Group B. There was nasal displacement of conjunctival autograft in 3 (12%) of patients on 1stpost-operative day in Group A whereas no graft displacement was seen in any case of Group B. Level of patient discomfort measured on visual analogue scale in Group A was (0.56 ± 0.92 on day 1, 0.40 ± 0.71 on day 7, 0.04 ± 0.20 on day 14 and 0 ± 0 on day 30). In Group B level of patient discomfort was (3.92 ± 1.12 on day1, 1.24 ± 1.09 on day 7, 0.12 ± 0.33 on day 14 and0 ±0 on day 30). Conclusions: The use of autologus blood to affix the conjuctival autograft in pterygium surgery is a reliable method. It is associated with less patient discomfort post operatively and requires shorter surgical time, as compared to conjunctival autograft with sutures.

Efficacy of suture less and glue-free conjunctival autograft in pterygium surgery

Efficacy of suture less and glue-free conjunctival autograft in pterygium surgery

Evaluation of Autologous Blood in Pterygium Surgery With Conjunctival Autograft.

Autologous blood has been used exploratively with conjunctival autograft in pterygium surgery. However, it is controversial whether autologous blood performed better than other fixation methods, including fibrin glue and sutures. This meta-analysis was conducted to evaluate the effectiveness of using autologous blood in pterygium surgery with conjunctival autograft. The study was conducted according to the PRISMA guidelines. The MEDLINE, Cochrane library, and Embase databases were systematically searched from their establishment until April 1, 2018. Randomized controlled trials comparing autologous blood with fibrin glue/suture in pterygium surgery with conjunctival autograft were included. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Outcome measurements were recurrence, graft displacement, graft retraction, and surgical duration. Review Manager 5.3 (Cochrane Community, Cochrane Collaboration, London, UK) was used to perform the statistical analysis. When I < 50%, statistical heterogeneity was considered acceptable, and a fixed-effects model was adopted; alternatively, the random-effects model was used. Seven randomized controlled trials including 516 patients were finally included in the meta-analysis. Four studies with 379 patients compared autologous blood and fibrin glue. Autologous blood was inferior to fibrin glue with respect to surgical duration, graft retraction, and graft displacement. However, there was no statistical difference between the 2 groups in terms of the recurrence rate. Four studies with 152 patients compared autologous blood and traditional suturing. Autologous blood was superior to sutures in terms of surgical duration and inferior to sutures in terms of graft retraction. No difference was detected in terms of graft displacement and recurrence rate. In conclusion, autologous blood is an appropriate method for graft fixation in pterygium surgery. Current research suggests that autologous blood derivatives may be a promising approach after pterygium excision. However, this requires further confirmation.

Healing of autologous conjunctival grafts in pterygium surgery.

To temporally study the healing of conjunctival autografts in consecutive patients following pterygium surgery. A case-cohort observational study. Thirty-two eyes of 28 patients who underwent pterygium surgery were included. All eyes had pterygium excision with conjunctival autografts. Twenty-seven eyes of 24 patients underwent excision of primary pterygium while five eyes of four patients had surgery for recurrent pterygium. All grafts were attached using fibrin glue. Mitomycin-C 0.04% was used intraoperatively in 25 eyes. All eyes were followed up at 1, 2, 4, 8, 12weeks and 6months postoperatively. Photographs were taken at each visit to monitor graft vessels, re-perfusion and healing. Main outcome measures were graft loss; re-perfusion of grafts and appearance and resolution of oedema, transudation and haemorrhage; approximation of graft edges to host bed and changes at donor site. No graft tissue was lost. In all eyes, healing of autografts started with graft swelling due to oedema and transudation followed by re-perfusion injury, which manifested as swelling, variable vessels calibre, patchy or diffuse haemorrhage occurring within first week and resolving by fourth postoperative week. Graft vessels anastomose with vessels in surrounding conjunctiva and underlying episclera to re-establish blood circulation. Retraction of graft edges from surrounding conjunctiva was uncommon with rapid epithelialization of exposed (epi)sclera. Conjunctival autografts in pterygium surgery follow a consistent healing pattern dominated by re-perfusion injury in early postoperative days. This produces dramatic changes in the autograft for which patients should be counselled before surgery. Conjunctival autografts are not at risk of falling off, losing epithelial cover or undergoing necrosis.

Pterygium excision and conjunctival autograft: A comparative study of techniques.

BACKGROUND:Use of conjunctival autograft following excision has reduced the recurrence rate of primary pterygium. This study compares the use of fibrin glue, autologous blood, and sutures in placing the conjunctival autograft in reference to surgical time taken, postoperative discomfort, and recurrence during follow-up.MATERIALS AND METHODS:Sixty patients with primary pterygium were included in the study and divided into three groups. In Group I, autograft was attached in place with help of 10-0 polyamide monofilament suture; in Group II, with autologous blood; and in Group III, with fibrin glue. All three groups were compared in terms of surgical time, postoperative discomfort, and recurrence.RESULTS:The average surgical time taken was least with fibrin glue group (Group III), i.e., 36.2 min, followed by 44.8 min with autologous blood group (Group II) and maximum of 53.3 min with suture group (Group I). Postoperative discomfort was seen maximum in th suture group (Group I) and was minimal in the fibrin glue group (Group III). At the end of final follow-up at 6 months, one case of recurrence was seen in both Group I and Group II. No recurrence was seen in Group III.CONCLUSION:The study concluded that fibrin glue remains the most effective method for attaching conjunctival autograft in pterygium surgery with least surgical time and postoperative discomfort. Autologous blood is an effective alternative which is easily available, economical, vis a vis fibrin glue with less surgical time and postoperative discomfort. Use of sutures is an older technique with maximum surgical time and postoperative discomfort. Recurrence is least with fibrin glue.

Comparison of autologous fibrin glue versus nylon sutures for securing conjunctival autografting in pterygium surgery.

To compare the safety, operating time, postoperative ocular signs, symptoms, overall patient satisfaction, complications rate and recurrence rate of autologous fibrin glue (AFG) and nylon suturing (NS) for attaching conjunctival autografts in pterygium surgery. A prospective, randomized, interventional study was performed among 120 patients (120 eyes) with primary pterygium. Superior conjunctival autograft was harvested and transferred on to bare sclera after pterygium excision. For attaching the autograft, AFG (n=60 eyes) and NS (n=60 eyes) were used. The patients were followed up for 12months. The groups were compared for the safety, operative time, postoperative ocular signs, symptoms, overall patient satisfaction, recurrence and complications rate. All conjunctival autografts in both groups were successfully attached. The average operating time for the AFG group was significantly shorter (P<0.001). Postoperative symptoms were fewer for the AFG group than the suture group. After 12months of follow-up, no recurrence was reported for the AFG group, but 8.3% of patients experienced recurrence in the NS group. Our study demonstrated the superiority of AFG to NS in saving operating time and elimination of recurrence without any complications in pterygium surgery. AFG can obviate the need for suturing and increases the viability of tissue flaps. Additional studies are necessary to determine the long-term effects considering factors such as primary or recurrent status of pterygium, age and sex of patient, dose and duration of treatment for mitomycin C.