A Clinical And Histopathological Study Of Superior Versus Inferior Conjunctival Autograft Using Fibrin Glue In The Management Of Primary Pterygium (original) (raw)
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A Clinical Study of Conjunctival Autograft Using Fibrin Glue in Primary Pterygium Surgery
Back ground: Pterygium is a common external Ocular disease in tropical countries like India. Excision of the pterygium is the only modality of the treatment for pterygium. Recurrence of pterygium is the most common complication following excision with the bare sclera technique. This was minimized by using autoconjunctival graft with sutures in primary pterygium surgery, but this is associated with sutures related complications. Fibrin glue is used to minimize the suture related complication in auto conjunctival graft surgery. AIM: To evaluate the safety and efficacy of conjunctivalautograft using fibrin glue, which minimize the suture induced complications Material & methods: It is a prospective study conducted in Ophthalmology dept. S.V. medical college Tirupati. 50 eyes of 50 patients with progressive pterygium were included in the study. Pterygium excision surgery with autoconjunctival graft using fibrin glue was done.The conjunctiva taken from the supero temporal quadrant of the same eye. Patients were followed for 6months to evaluate post operative complications and recurrence of pterygium. Results: Of the 50 patients incidence was similar in both sexes. Majority of the patients [60% ] belonged to the age group of between 30-50 years. Major post operative complications observed in this study were graft oedema (16%) and haemorrhage[ 8%] of the patients. The follow up period was uneventful with minimum complications. No recurrence of pterygium was seen during follow up period. Conclusion: The case series suggests that fibrin glue is a safe and useful alternative method for graft fixation in primary pterygium surgery
International Journal of Health Sciences and Research, 2014
Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing primary pterygium excision. Methods: This was a prospective comparative clinical study. A total of 80 patients (80 eyes) with primary nasal pterygium were randomized to undergo pterygium excision and conjunctival autografting using either fibrin glue (40 eyes) or 10-0 nylon suture (40 eyes). Patients were followed up for 6 months. The groups were compared in terms of duration of surgery, degree of postoperative discomfort, inflammation, subconjunctival haemorrhage, graft stability and pterygium recurrence. Results: The mean surgery time in fibrin glue group was 14.5 minutes and in suture group was 26 minutes (p=0.000). Fibrin glue group had significantly lesser postoperative discomfort (p=0.000) and inflammation (p=0.001) compared to suture group at post-op day 1 and week 1, with no difference at subsequent follow-ups. No significant difference was found in degree of sub...
Fibrin Glue Versus Autologous Serum for Conjunctival Autograft Fixation in Pterygium Surgery
Pakistan Journal of Ophthalmology, 2020
Purpose: To compare the outcomes of conjunctival autograft fixation using autologous serum vs fibrin glue to cover the bare sclera in pterygium excision surgery. Study Design: Quasi experimental study. Place and Duration of Study: The study was conducted in Ophthalmology Department of CMH Kharian from April 2018 to November 2018. Material and Methods: Forty patients with primary pterygium were selected by convenient sampling technique. Patients with recurrent Pterygia and moderate to severe dry eyes, keratitis or secondary to trauma were excluded. The patients were divided into two groups, group A treated with fibrin glue and group B treated with autologous serum technique. All patients underwent pterygium excision under topical anaesthesia. The conjunctival autograft was removed from superior temporal bulbar conjunctiva to cover the scleral bed produced by pterygium excision. Post operatively the patients were followed-up for three months to assess the fixation or otherwise. Da...
IOSR Journals , 2019
Pterygium is a degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue to invade cornea, destroying superficial layers of stroma and Bowman's membrane, the whole being covered by conjunctival epithelium. The surgical excision is the main treatment method of pterygium. Various techniques have been tried in past from simple excision to use of adjunct therapies such as beta-radiation, thiotepa, 5-FU, and mitomycin C. Traditionally, during pterygium surgery the conjunctival autografts are secured in place with either absorbable or nonabsorbable sutures. Other techniques have been developed in order to reduce the recurrence and to improve the postoperative comfort. One such modality is usage of fibrin glue instead of sutures. This study has been undertaken to evaluate the efficiency of fibrin glue as compared to sutures in attaching the conjunctival autograft with special reference to surgical time, post-operative comfort and recurrence during follow up. In this study it was found that, the mean surgical time was shorter when fibrin glue was used instead of sutures and recurrence rate was 1.28% after pterygium excision with conjunctival autografting using fibrin glue and 2.24% after excision and autografting with suture.
International ophthalmology, 2017
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 12 months. 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 gro...
British Journal of Ophthalmology, 2009
Aims: To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery. Methods: Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardised digital slit-lamp photographs were taken at 1 week, 1 month and 3 months postoperatively. Sutures were masked using commercially available photoediting software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability. Results: 34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) postoperatively. No significant difference was found for inflammation at 1 week postoperatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076 and p = 0.624, at 1 week, 1 month and 3 months, respectively). No significant difference was found in degree of postoperative SCH between the groups (p = 0.417, p = 1 and p = 1, at 1 week, 1 month and 3 months, respectively). Conclusion: This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery not only are as stable as those secured with sutures, but also produce significantly less inflammation.
Fibrin glue versus autologous blood for conjunctival autograft fixation in pterygium surgery
Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2015
To compare the outcomes between autologous blood-and fibrin glue-fixated conjunctival autografts in pterygium excision surgery. Design: Retrospective case series. Participants: Forty eyes of 40 patients who had a primary nasal pterygium excision. Methods: A retrospective comparative case series of 40 eyes (40 patients) that had a primary nasal pterygium excision. All eyes had a conjunctival autograft from the superior bulbar conjunctiva to cover the scleral bed. Twenty eyes (20 patients) had fixation of the autograft using autologous blood (AB), and 20 eyes (20 patients) had fixation using fibrin glue (FG). One year of follow-up data included conjunctival graft stability (graft loss, graft retraction), pterygium recurrence, visual acuity, and postoperative complications. Descriptive and inferential statistics were performed. Results: Intraoperatively, no complications occurred in either group. Graft loss occurred in 6 patients in the AB group, compared with none in the FG group. Graft retraction occurred in 3 patients in the AB group and 2 patients in the FG group. At 1 year postoperatively, pterygium recurrence occurred in 4 patients in the AB group and 1 patient in the FG group. One patient in the AB group developed a small pyogenic granuloma that resolved by 6 months with conservative management. Visual acuity remained stable in both groups. Conclusions: Conjunctival autograft fixation with autologous blood resulted in less stable conjunctival autografts and a higher recurrence rate compared with fixation with fibrin glue. Objet : Comparer les résultats, dans des cas d'excision du ptérygion, entre l'utilisation de sang autologue et l'utilisation de colle à la fibrine pour une autogreffe conjonctivale. Nature : Étude de cas rétrospective. Participants : 40 yeux de 40 patients ayant subi une excision du ptérygion primaire en nasal. Méthodes : Étude de cas rétrospective comparative de 40 yeux (40 patients) ayant subi une excision du ptérygion primaire en nasal. Tous les yeux ont reçu une autogreffe conjonctivale de la conjonctive bulbaire supérieure pour couvrir la cavité sclérale. Pour 20 yeux (20 patients), l'autogreffe a été fixée à l'aide de sang autologue (SA), et pour les 20 autres (20 patients), à l'aide de colle à la fibrine (CF). À l'examen de suivi de 12 mois, ont été examinés : la stabilité de la greffe conjonctivale (résorption ou rétraction du greffon), la récurrence du ptérygion, l'acuité visuelle et les complications postopératoires. Des statistiques descriptives et déductives ont été calculées. Résultats : Pendant l'opération, aucune complication n'a été constatée dans les deux groupes. Une résorption du greffon a été constatée chez 6 patients du groupe SA, mais chez aucun du groupe CF. Une rétraction du greffon a été constatée chez 3 patients du groupe SA et chez 2 patients du groupe CF. Après le suivi de 12 mois, une récurrence du ptérygion a été signalée chez 4 patients du groupe SA et chez 1 patient du groupe CF. Un patient du groupe SA a développé un petit granulome pyogène qui s'est résorbé après 6 mois de traitement. L'acuité visuelle est demeurée stable chez les patients des deux groupes. Conclusions : L'utilisation de sang autologue pour une autogreffe conjonctivale donne des résultats moins stables et un taux de récurrence plus élevé que l'utilisation de colle à la fibrine.
IP International Journal of Ocular Oncology and Oculoplasty, 2017
The present study was undertaken to assess the efficacy of fibrin glue versus suture in patients undergoing conjunctival autograft with special reference to operating time, post-operative outcomes and post-operative visual outcomes during follow-up. Design: Two years prospective randomized controlled trial was conducted for 40 patients who presented to the department of Ophthalmology, who fulfilled inclusion criteria and were willing to enrol in the study. Method: After taking informed consent, detailed history regarding patients name, age, sex, occupation, address, presenting symptoms, duration, progression, and associated conditions was recorded. Patients were then randomized into two Groups: Conjunctival autograft with suture (Group 1) and Conjunctival autograft with fibrin glue (Group 2). Following parameters were noted in both Groups (1) Operating time in both Groups (2) Post-operative outcomes like pain, foreign body sensation. (3) Visual outcomes in both groups. Results: The mean operating time in fibrin group was 30.950 minutes (SD= 2.946), whereas in suture group, the mean operating time was 43.40 minutes (SD = 2.703). On post-operative day one, 15 (75%) patients had pain in fibrin group whereas in suture group all 20 (100%) patients had pain. Foreign body sensation was present among 80% patients on post-operative day one, 90% on day three, 25% on day ten, 5% during week three and 0% at the end of the follow up as compared to suture group where all the patients (100%) complained about foreign body sensation on post-operative day one and three which decreased to 90% on post-operative day ten and persisted among 80% at week three and 10% at week six. The mean pre-operative uncorrected log MAR values were 0.390 (SD=0.161) which decreased to 0.190 (SD=0.085) in fibrin group. Conclusion: There was marked reduction in operating time and post-operative pain and foreign body sensation in fibrin group as compared with suture group.
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