Conjunctival Autograft Technique Research Articles

DIFFERENT CONJUNCTIVAL AUTOGRAFT TECHNIQUES FOR PTERYGIUM SURGICAL EXCISION, A CASE SERIES

Abstract
 Introduction : Pterygium is a wing shaped fibrovascular growth that extends from the conjunctiva onto the cornea. There are many techniques available for pterygium removal, from simple excision to excision and repair of the defect with modified techniques.
 Case Illustration : 1. A 50-year-old woman presented with a grade II pterygium in both of her eyes. She was undergone sliding flap pterygium excision for her right eye. Case 2. A 32-year-old man presented with a grade II pterygium in his left eye. He was then undergone rotational flap pterygium excision for his left eye. Case 3 A-55-year-old woman presented with a grade II-III double head pterygium. She was later undergone modified conjunctival autograft double head pterygium excision for his left eye.
 Discussion : Surgical management is the gold standard for pterygium treatment. Indications for pterygium excision include decreased visual acuity due to astigmatism, obstruction of visual axis, repeated irritation and cosmetics. Surgical techniques for excision of the pterygium include bare sclera excision, tissue grafting using conjunctival graft, membrane transplantation amnion and limbal- conjunctival autograft. There are several choices of conjunctival graft techniques after pterygium excision, such as conjunctival sliding flap, conjunctival rotational flap, and modified conjunctival autograft. Modified conjunctival autograft technique was performed for double head pterygium management. The technique consisting of horizontally modified conjunctival autograft and vertically modified conjunctival autograft.
 Conclusion : The choices of surgical excision techniques for pterygium depends on the grades of the pterygium and operator’s preference.

Study of biomarkers p53, Ki-67, Bcl-2, and VEGF in pterygium.

To study the biomarkers present in primary pterygium samples of patients of Indian ethnicity and compare it with the samples obtained from the unaffected conjunctiva of the same eye. A prospective case-control study of 17 eyes in patients above 10 years of age with primary pterygium who underwent pterygium excision using limbal conjunctival autograft technique. The pterygium samples (cases) and conjunctival samples (controls) were sent for immunohistochemical (IHC) staining for the following biomarkers: p53, Bcl-2, Ki-67, and vascular endothelial growth factor (VEGF). The immunohistochemistry of the samples and the controls revealed p53 positivity in 47.05% of pterygium samples and 29.4% of controls ( P < 0.587). Nine cases each in pterygium and control samples were positive for Ki-67 expression. Differences in the staining pattern between the two groups were not statistically significant ( P < 1.000). Bcl-2 positivity was seen in 10 pterygium samples (58.8%) and 12 controls (70.5%), with no statistical difference between the two groups ( P < 0.455). VEGF expression was seen in both epithelial and endothelial cells of the samples and controls, with no statistical difference between the two groups, with P = 1.000 for the epithelial staining and P = 0.637 for endothelial staining. The expression of biomarkers was comparable in both groups. We conclude that pterygium, against common belief, might not be a localized disease process but a global ocular phenomenon where the apparently healthy tissue also has some ongoing disease process at a molecular level.

Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan

Introduction: Pterygium is a degenerative condition of the conjunctiva characterized by fibro vascular growth of tissue onto the cornea, often necessitating surgical treatment. Currently the conjunctival autograft technique using either suture or fibrin glue is the preferred method of treatment. The aim of the study was to evaluate the outcome of Pterygium surgery using sutures and glue to fix the graft. Methods: This observational study was carried out at the tertiary eye hospital, involving fifty-one patients (51 eyes) with primary Pterygium who underwent Pterygium surgery using either suture (19 eyes) or fibrin glue(32 eyes). The outcome measures were operative time, post-operative symptoms (pain, photophobia, foreign body sensation), and graft complications (displaced, edema, hemorrhage). Patients were followed up on day1, day 7, and day 28 after the surgery as per the standard protocol. Results: The study consisted of 17 males and 34 females, with mean ages of 51.95 (SD 9.82) in the suture group and 51.75 (SD 5.77) in the fibrin glue group. In the suture group, mean operation time was 14.16 (SD 2.71) minutes, and in the fibrin glue group, it was 13.72 (SD 4.54) minutes. With regard to the post- operative symptoms, the intensity of foreign body sensation was found to be higher in the suture group on day 1 and day 7 (p&lt;0.003 and p&lt;0.001, respectively). However the foreign body sensation was not observed in both groups on day 28. There was no significant difference in symptoms like Pain and photophobia. Notably, no graft complications were observed in either group on day 28. All patients completed the required follow ups. Conclusions: The use of fibrin glue in Pterygium surgery with conjunctival autografts relatively reduces surgery time and decreases early post-operative foreign body sensation thus improving early post-operative patient comfort compared to sutures.

The role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing: a literature review

Link of Video Abstract: https://youtu.be/8w4jBvx0pJc Background: Plasma-rich fibrine (PRF) membrane is a new biomembrane useful in ocular surface reconstruction technique. Since its development, PRF membrane has been used successfully in many studies; however, some controversies maintained. This literature study aims to evaluate the role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing. Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to compare the effect of PRF membrane and conjunctival autograft on TGF-β and type 1 collagen expression. Results: PRF has many advantages, such as the ability to reduce inflammation, rich in growth factors, and can be a temporary scaffold for fibroblast migration. However, despite its advantages, PRF is not widely used, unlike its counterpart techniques, such as conjunctival autograft. Conjunctival autograft has long been used as an option for ocular surface reconstruction techniques, but it has some limitations. The conjunctival autograft technique cannot be performed in large or bilateral conjunctival damage. Thus, the PRF membrane technique can become a perfect solution for such a case. This literature review will provide more information on how PRF can regulate inflammation and support the conjunctival wound healing process. Conclusion: Some impacts of PRF membrane and conjunctival autograft are still unclear, especially their effect on TGF-β and type 1 collagen expression. This literature review is expected to encourage and support future experimental studies about the impact of PRF and conjunctival autograft on TGF-β and type 1 collagen expression.

Comparison of Conjunctival Autograft Versus Bare Sclera Technique as Treatment Modalities for Primary Pterygium

Background: Pterygium is a fibrovascular conjunctival growth within the palpebral fissure extending onto the corneal surface. Recurrence is a common post-op complication of pterygium excision surgery, with various rates depending on the techniques used for its excision. Objective: Comparison of conjunctival autograft versus bare sclera technique as treatment modalities for primary pterygium. Material &amp; Methods: This study was done in the Department of Ophthalmology of tertiary care hospital. In a prospective randomized controlled trial a sample size of 102 eyes with primary pterygium were allocated into two equally sized groups (51 patients in each): Group A underwent pterygium excision by bare sclera method, Group B underwent pterygium excision followed by conjuctival autograft. Both groups were analyzed and compared, for recurrence and complications with a mean follow-up time of 3 months. Result: Pterygium recurrence was detected in 16 (31.37%) patients using bare sclera technique (group A) and in 4 (7.84%) patients using conjuctival autograft technique (group B), that reveal a statistically significant difference (p = 0.003) Conclusion: Both surgical techniques are effective for pterygium excision but there is a statistically significant difference (p = 0.003) of pterygium recurrence between both techinques. Pterygium excision with conjuctival autograft should opt for better results in terms of recurrence as well as other complications. Bare sclera technique can be opted for preserving conjunctiva in case of glaucoma or scaring but at the expense of pterygium recurrences. Keywords: Pterygium, conjunctival autograft technique, bare sclera, recurrence.

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Introduction: Excision of the pterygium has been shown to enhance tear film stability. The study was designed to assess the effects of pterygium removal utilising two different surgical procedures on tear film parameters: bare sclera with Mitomycin C (MMC) and conjunctival autograft. The bare sclera with MMC application and conjunctival autograft techniques are the two most common treatments for pterygium. Conjunctival autograft is a procedure in which the superior conjunctiva of the patient's eye is removed in one piece and the excised tissue is used to cover the area where the pterygium was removed.The bare sclera with MMC application procedure involves removing the pterygium and intraoperatively applying 0.02% MMC to the scleral bed, leaving it to re-epithelialise. Aim: Comparative analysis of improvement in tear film parameters of patients undergoing pterygium excision by conjunctival autograft or bare sclera technique augmented by intraoperative MMC application. Materials and Methods: The prospective interventional study was conducted in Department of Ophthalmology, SGT University affiliated hospital, Gurugram, Haryana, India, from January 2019 to January 2020. A total of 54 Patients were divided into two groups. Group 1 has 26 patients undergoing pterygium excision with bare sclera technique (with MMC 0.02%), and Group 2 has 28 patients undergoing pterygium excision with conjunctival autograft technique (with MMC). Tear Break-up Time (TBUT) and Schirmer's I were measured in 54 eyes with pterygium before and after surgery. Data analysis was done using Two tail (inequality) test on Statistical Package for the Social Sciences (SPSS) software version 28.0. Patients were randomly divided into two groups by using RAND between software. Results: The mean preoperative Schirmer's I was 9.333 mm which improved to 12.203 mm after pterygium excision, which was a statistically significant change irrespective of the technique used. The mean preoperative Tear Break-up Time (TBUT) was 7.212 seconds which improved to 13.059 seconds after pterygium excision, which was a statistically significant change irrespective of the technique used. In the autograft group, TBUT improved from preoperative mean value of 7.253 seconds to 14.0 seconds and Schirmer's I mean values improved from 9.178mm to 12.678 mm, respectively.In the bare sclera group TBUT improved from preoperative mean value of 7.169 second to 12.046 second and Schirmer's I mean values improved from 9.500 mm to 11.692 mm, respectively. The mean postoperative Schirmer’s1 in autograft technique was 12.678 mm and postoperative Schirmer’s1 in bare sclera technique was 11.692 mm.The postoperative improvement in both groups was statistically similar. The mean postoperative TBUT in autograft technique was 14 seconds and postoperative TBUT in bare sclera technique was 12.046 seconds. Postoperative results in the autograft group were statistically better than the bare sclera group. Conclusion: The tear film stability parameters in pterygium patients improved after surgery in both the groups. Statistical analysis of postoperative Schirmer's I data was similar in both the techniques. Although postoperative TBUT values were statistically better in the autograft group, the mean value in both the techniques were more than ten seconds. The analysis of data indicates that bare sclera technique with MMC can be used as an alternative surgical procedure in patients with scarred conjunctiva or in situations where superior conjunctiva has to be preserved for future use.

Comparison of pterygium recurrence with and without using postsurgical topical cyclosporin a 0.05%: A randomized clinical trial

Purpose:To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery.Methods:In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared.Results:The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99).Conclusion:The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

Evaluation of the Effect of Cryotherapy in Limbal Conjunctival Autograft Technique in Pterygium Surgery

Aim: To compare the complication and recurrence rates in patients undergoing limbal conjunctival autograft with or without adjuvant cryotherapy for primary or recurrent pterygia.Methods: All information about the cases operated between January 2014 and January 2019 was scanned from the electronic database. Fifty-three eyes undergoing limbal conjunctival autograft combined with cryotherapy were classified as Group 1, and 47 eyes undergoing only limbal conjunctival autograft were classified as Group 2. Any development of new fibrovascular tissue from the limbus to the cornea after surgery was considered a recurrence. Any complications occurring during and after surgery were noted.Results: In Group 1, 45 of the 53 patients had primary and eight had recurrent pterygia. In Group 2, 41 of the 47 patients had primary and six had recurrent pterygia. Both groups were similar in terms of age and gender (p=0.880 and p=0.835, respectively). The mean follow-up period was 27.0±8.6 months in Group 1 and 28.7±7.8 months in Group 2 (p=0.287). No recurrences were observed during the follow-up period in Group 1, while the recurrence rate in Group 2 was 10.6% (p=0.02). All relapses occurred within the first year. No complications were observed during surgery in either group. Graft oedema was observed in the early post-operative period in four patients in Group 1 and three patients in Group 2.Conclusion: Limbal conjunctival graft technique combined with cryotherapy is a successful and reliable method in the treatment of primary and recurrent pterygium.

Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials &amp; Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P&lt;0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P&lt;0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

Impact of fibrin glue versus suture closure on double-headed pterygia in Asian eyes – a 7-year study in a tertiary institution

Background To compare the recurrence rate and outcomes of double-headed pterygia using fibrin glue versus suture closure of conjunctival autograft. Methods All patients with double-headed pterygia who underwent pterygia excision with conjunctival autograft from January 2012 to January 2019 in the National University Hospital of Singapore were included. Patients were divided into 2 groups depending on whether fibrin glue or sutures were used to secure the conjunctival autograft in place. All patients had a minimum of 6 months follow-up. Results A total (26 patients) of 22 eyes had fibrin glue, while eight eyes underwent suture closure of their conjunctival autograft. Fibrin glue group had 4.5% recurrence rate, while suture group had 37.5% recurrence rate (p = .021). There is statistically significant improvement for overall visual acuity (p = .009) and cylinder (p = .002). There is also statistically significant improvement for visual acuity in the glue group (p = .026), but not in the suture group. Fibrin glue group had a shorter operation duration time compared to suture group (p < .001). There were no cases of graft dislocation, contraction or limbal stem cell deficiency. Conclusions Low recurrence rates and good postoperative visual outcomes can be achieved with the split conjunctival autograft technique. Our study suggests that fibrin glue has an additional benefit over the use of sutures in the management of these complex cases.

Comparison of horizontal versus vertical split conjunctival autograft in the management of double head pterygium: A retrospective analysis.

Purpose:To compare horizontal and vertical split conjunctival autograft technique in the management of double head pterygium.Methods:Retrospective analysis of 96 and 99 eyes with double head pterygia that underwent horizontal (Group 1) and vertical (Group 2) split conjunctival autografting, respectively. Comparison of recurrence rates and other complications was done.Results:Recurrence was seen in 5.2% and 4% of the eyes in Groups 1 and 2, respectively (P > 0.05). Other complications like subconjunctival hemorrhage, graft edema, graft retraction, granuloma, and graft loss were also comparable among the two groups.Conclusion:Both the techniques provide good results with comparable efficacy in terms of rates of recurrence and complication profiles.

RECURRENCE RATE AFTER CONJUNCTIVAL AUTOGRAFT VESUS INTRAOPERATIVE MITOMYCIN C FOR TREATMENT OF PRIMARY PTERYGIUM

ABSTRACT Background: pterygium is a common disease that affect many people in the world especially in the tropics and in an equatorial zone between 30° north and south latitudes. Egypt is one of the highly affected contraries. The most important problem in treatment of pterygium is high recurrence rate. Aim: to compare conjunctival autograft and intraoperative mitomycin C to determine the best technique that can reduce the recurrence rate. Methodology: this prospective interventional study comprised 40 eyes of 40 patients with primary pterygium included from the outpatient clinics of the ophthalmology departments at Al-Zahraa University Hospital and The Italian Military Hospital over a period of 15 months (from March 2019 to May 2020). They were randomized into two groups according to the adjuvant used: (1) intraoperative 0.02% MMC for 3 minutes or (2) conjunctival autografting technique. Patients were followed for recurrence and complications for a period of 6 months. Results: 40 eyes of 40 patients their age ranged from 21 and 65 years in group (1) and between 27 and 60 years in group (2) with a male predominance of 30 cases (75%). There were 2 recurrences (10%) in MMC group and 1 recurrence (5%) in conjunctival autograft group. There was no statistically significant difference in the recurrence rate between the two groups. There were 2 cases of granuloma one case in each group and one case of partial graft dehiscence in group 2. Conclusion: Both conjunctival autograft and intraoperative mitomycin C techniques are effective treatment modalities for treatment of primary pterygium and for reduction of recurrence rate. There is no significant difference between both techniques as regards the recurrence rate.

Role of Surgeon Experience in Pterygium Surgical Outcomes: A Comparative Study Between Ophthalmology Resident and Consultant.

PurposeAlthough surgical technique and patient variables are responsible for the recurrence of pterygium, the surgeon's experience has been sparsely studied. This retrospective study was designed to compare the surgical time, complications, and rates of recurrence after primary pterygium excision between consultant ophthalmologists and trainee residents.Material and methodsIn this retrospective study, we collected the data of 176 primary pterygium eyes, who were operated on with excision and sutureless/glueless conjunctival autograft either by the consultant (group A) or by the trainee (group B). The demographic profile, surgical time, complications, and recurrences between both groups were analyzed.ResultsBoth the groups were comparable with regards to age, gender, religion, side of the eye, size of the pterygium, and duration of follow-up. The mean operative time was longer in group B (26.5+/-3.8 minutes) than group A (14.2+/-1.6 minutes). Though a relatively higher percentage of complications was observed in group B (12% vs. 9%), the difference was statistically not significant (Mann-Whitney U test, p-value 0.271). There was no statically significant difference in recurrence rate (6.8% vs 9.4%) between the groups.ConclusionWith regards to the role of surgeon experience in primary pterygium excision using the sutureless and glueless conjunctival autografting technique, the residents did not have any statistically significant differences in their postoperative complications and recurrence rates. However, the surgical time was significantly higher in the resident group owing to the learning curve.

A COMPARATIVE STUDY OF CONJUNCTIVAL AUTOGRAFT AND BARE SCLERA TECHNIQUES IN THE TREATMENT OF PTERYGIUM

Objective: Pterygium is a fibrovascular growth encroaching from the conjunctiva into the cornea. This study deals with the comparison of conjunctival autograft and bare sclera technique as treatment options for pterygium.&#x0D; Methods: This study was done in the ophthalmology department of Saveetha Medical College, Thandalam, Chennai. A total of 100 patients were diagnosed of pterygium was taken for the study, out of which 60 patients were operated on with conjunctival autograft and 40 patients were operated with bare sclera technique. Patients with hypertension, diabetes mellitus were excluded. Post-operative complications and recurrence were noted. All the patients were between the age group of 20-65 y.&#x0D; Results: The mean age of patients operated with conjunctival autograft was 43.6, whereas in bare sclera technique was 46.625. The maximum age was 63 and the minimum age was 23 in conjunctival autograft whereas in bare sclera technique, the maximum age was 64 and the minimum age was 22. The recurrence rate of pterygium in conjunctival autograft was 1 and the recurrence rate of pterygium in bare sclera technique was 4.&#x0D; Conclusion: The present study revealed that conjunctival autograft was a better treatment option compared to the bare sclera technique for excision of pterygium

Assessment of Preoperative and Postoperative Changes in Corneal Astigmatism after Pterygium Excision by Different Techniques

Background: Pterygium causes visual problems due to induced corneal astigmatism or direct encroachment onto the visual axis. The present study was conducted to compare preoperative and postoperative changes in corneal astigmatism after pterygium excision by different techniques. Subjects and Methods: The present study was conducted from May 2018 to August 20018 on 69 patients of age range 20-55 years of primary Pterygium. Patients were divided into three groups of 23 each. Group I was treated with bare sclera (BS) technique, Group II with conjunctival autograft (CAG) technique and Group III with amniotic membrane graft (AMG) technique. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were recalled on day 5, 1 month, and 3 months for the analysis. Results: Uncorrected visual acuity (UCVA) preoperatively was 0.57, on the 5th day was 0.45 after 1 month was and after 3 months was 35. The mean preoperative astigmatism value in group I was 3.45, in group II was 3.52 and in group III was 3.49. Postoperative astigmatism value in group I was 1.60, in group II was 0.92 and in group III was 0.81. The difference was significant (P&lt; 0.05). Conclusion: Authors found that amniotic membrane graft and a conjunctival autograft is better surgical techniques than bare sclera in reducing astigmatism.

Recurrence rate of pterygium following Excision by bare sclera technique versus conjunctival autograft

To compare the post operative results of pterygium excision surgery by bare sclera technique versus conjunctival autograft technique.Retrospective analysis of patients who underwent pterygium excision with either bare sclera technique or with conjunctival autograft between March 2015 to March 2020 was done. Data of 38 eyes was shortlisted and analyzed. Data analysis was done using Microsoft Excel 2017 and SPSS Software.38 patients were shortlisted and divided into two groups. Bare sclera technique (Group A) was used in 19 patients, whereas Pterygium excision with conjunctival autograft (Group B) was done in 19 patients.There was no major vision threatening complications in any group. Moreover, there was not a single case of graft rejection or graft shedding in group B.Comparison of the groups showed that the rate of recurrence was more in group A (Bare Sclera Technique Group) as compared to group B (Excision with Autograft method). Although conjunctival autograft technique is comparatively difficult and time consuming, but cosmetic results are better and rewarding.

Comparison between fibrin glue and polyglactin sutures in limbal based conjunctival autograft technique in primary pterygium surgery in adults- A randomised controlled trial

Pterygium is a slow growing, wing shaped, elastoticsubconjunctival degeneration within the palpebral fissure involving the cornea. As it encroaches the limbus, it proliferates as vascularised granulation tissue destroying the superficial stroma and Bowman’s membrane and is characterized by tissue remodelling, cellular proliferation, neovascularisation and inflammation. To compare between fibrin glue and polyglactin sutures in limbal based conjunctival autograft technique in primary pterygium surgery in terms of duration of surgery and early and late post-operative complications. It was a prospective comparative, randomized controlled trial which was conducted at North Bengal Medical College, Darjeeling, from July 2016 to June 2017. Patients with progressive pterygium diagnosed after proper clinical examinations and admitted for excision with conjunctival autograft attached with fibrin glue or for excision with conjunctival autograft sutured with 8-0 polyglactin. Data were collected and analysed. 52 patients were randomly and equally divided into two groups, group A (fibrin glue) and group B (sutured with polyglactin) according to the type of surgery. In both the groups, there was female preponderance and the average age of the patients were 45.15 (±5.576) and 40.65 (±8.299) years respectively. Regarding the post-operative complications such as graft oedema (p= 0.002, χ2 =10.035, df = 1), graft granuloma (p =.037, χ2 = 4.333, df = 1) and recurrence (p = 0.638, χ2 = 0.221, df = 1), the group A had less incidence than group B. The reduction of complications was statistically significant in group A in terms of graft oedema and graft granuloma but not in recurrence.

DISCRETION VALUES OF LIMBAL STEM CELL GRAFT WITH COMPARISON OF CONJUCTIVAL AUTOGRAFT IN PTERYGIUM EXCISION

Objective: To determine the recurrence rate of pterygium in cases treated with limbal stem stem cell graft versus connjuctival autograft. Materials and Methods: It was a randomized clinical trial conducted in Opthalmology department of Hayatabad Medical Complex Peshawar from January 2018 to February 2019 i.e one year study duration . A total of 60 diagnosed cases of pterygium of both sexes and all ages were included in the study . The cases were randomized into two groups i.e 30 cases were treated with stem cell graft while the other 30 cases were treated with conjunctival autograft .The recurrence rate of pterygium was determined in both the groups by following them for 6 months i.e at 1st , 3rd and 6th month of excision. Recurrence rate was calculated for both the procedures. Mean and standard deviations were used for quantitative variables while frequency and percentages were used for qualitative data. Results: A total of 60 diagnosed cases of pterygium were included in the study. Age of the study sample ranged from 22-55 years, with mean of 37±9.3 SD. About 36 (60%) cases were males and ,14 (40%) cases were females. Recurrence rate of pterygium was 3.3% in cases treated with limbal stem cell graft technique as compared to recurrence rate of 10% which was seen in cases treated with conjunctival autograft technique. Conclusion: Recurrence rate of pterygium was more in cases treated with conjunctival autograft as compared to those treated with limbal stem cell graft. So, limbal stem cell graft is more effective as compared to conjunctival autograft in treating pterygium and should be preferred treatment option for pterygium in order to decrease the recurrence rate and hence morbidity of the patient.

Comparison of Conjunctival Autograft Technique Using Autologous Blood as Glue Versus Suture Technique in Pterygium Surgery

Aim: To compare the post-operative inflammation, surgical time and complications in conjunctival autografting with oozed autologous blood versus sutures in primary pterygium surgery.&#x0D; Study Design: Prospective interventional study.&#x0D; Place and Duration of Study: Department of Ophthalmology, CIMS, Bilaspur (C.G), India. (Jan 2017-May 2018).&#x0D; Methodology: 80 eyes of 80 patients (25 to 75 years) presented with primary pterygium up to grade 3 were included in this prospective interventional study presented in eye OPD, CIMS, Bilaspur (CG). All the procedures and post-operative evaluation was done by the same surgeon. All the patients were divided into two groups on alternate basis. 40 patients received conjunctival autografting with oozed autologous blood (CAGb) and 40 patients received sutures (CAGs). These two groups were then compared for post-operative inflammation, surgical time and complications (day 1, day 5, 2 weeks, 1 month and 3 month).&#x0D; Result: Total 80 patients were evaluated after surgery. Progressive pterygium was observed in more than 50% cases in both groups. Post-operative inflammation and discomfort was significantly lower in CAGb group compared to CAGs group (P&lt;.001). Mean surgical time was also significantly less in CAGb group (11.6±2 min) compared to CAGs group (21.6±3min) (P&lt;.001). In CAGb group 5% patients had graft displacement while none in CAGs group. Granuloma formation was higher in CAGs group (12.5%) compared to CAGb group (7.5%). Subgraft haemorrhage was 10% in CAGb and 17.5% in CAGs group. Dellen formation was seen in 3 patients in CAGb and 4 patients in CAGs. Recurrence rate was higher in suture group (5/40 in CAGs vs 1/40 in CAGb).&#x0D; Conclusion: Our study concludes that placement of conjunctival autograft with oozed autologous blood as adhesive after pterygium excision is an effective, less inflammatory and less time consuming approach, with significantly lower rates of post-operative complications. This can be used as a better alternative to suture technique.

Sutureless Glueless Conjunctival Autograft for Primary Pterygium Surgery

Background: Pterygium is a fibrovascular growth of an abnormal conjunctival tissue that progressively encroaches the limbus and then onto the cornea invading its superficial layers. It is a common ophthalmic condition seen mostly in dry, dusty areas. Objective: The aim of the current study was to evaluate the sutureless glueless conjunctival autograft for primary pterygium surgery as regard technique, complications and success rate. Patients and methods: This prospective study included a total of 30 patients with primary nasal pterygium, attending at Outpatient Clinic of Ophthalmology Department, Al-Azhar University, Damietta. This study was conducted between March 2017 to March 2018. Results: When comparing post-operative values at the end of third month with the first month we have found no difference in corneal state for all patients. The patient with corneal opacity was as the first month and had no difference in corneal state or BCVA. We detected one patient (3.3%) having recurrent pterygium. Finally when comparing post-operative values at the sixth month with the third month, we have found another patient who was reported with recurrent pterygium. Thus, the recurrence rate was 2 patients (6.7%) among all studied patients and the other values were approximately the same. Conclusion: This study suggests that sutureless glueless conjunctival autograft technique is a safe, simple, easy of performance, has less surgical time and very effective for the management of primary pterygium.