A One Year Randomized Clinical Trial To Evaluate The Efficacy Of Conjunctival Autograft With Fibrin Glue And Autologous Blood In Pterygium Surgery At Kles Dr.Prabhakar Kore Hospital And Mrc, Belagavi

Abstract

BACKGROUND: Pterygium is a common ocular disorder.It is a degenerative condition ofthe conjunctiva in which the subconjunctival tissue proliferates as vascularized granulation tissue and invades the cornea mainly, superficial layers of stroma and Bowman’s membrane. Various methods of surgical excision have been described each having its own advantages and disadvantages. Currently, conjunctival autograft technique is the most widely practiced. Many modifications of the same have been introduced with advantages of lesser costs and lower rates of recurrence. Clinical trials have been done to compare the efficacy of graft with sutures or fibrin glue in comparison with that of autologous blood. If it can be proven that the outcomes with autologous blood is equivalent to that of fibrin glue or sutures then the advantages will include lower recurrence along with cost effectiveness. AIMS AND OBJECTIVES:To compare the following parameters in pterygium excision surgery with conjunctival autograft with fibrin glue and autologous blood: 1. Graft stability 2. Postoperative outcomes like pain, foreign body sensation, lacrimation, discomfort during blinking, presence of subconjunctival hemorrhage, displacement of graft,overall appearance of the eye and complications like graft dehiscence ,graft retraction and graft site papilloma. MATERIALS AND METHODS: It is a prospective,randomized clinical trial of patients with will pterygium in which 50% of the patients will undergo pterygium excision with conjunctivalautografting using fibrin glue and 50% patients will undergopterygium excision with conjunctivalautografting using autologous blood. The study population was selected from the patients attending Ophthalmology OPD at KLES Dr.Prabhakar Kore Hospital and Medical Research Centre.The study periodwas from January 2018 to December 2018. RESULTS: A total of 64 eyes were included in the study. Each group had 32 eyes. Cases with primary pterygium were included in the study. Mean age in Group I was 49.13 years and 47.22 years in Group II. In this study it was observed that 5.4% belonged to grade I, 63% to grade II and 2.3% to grade III. Maximum incidence of pterygium was seen in the age group of 41– 50 years. Majority of them were females (73.4%).At the first postoperative day, pain was seen in28% of patients in group I and 34% in group II which reduced to 0% in group I and 9% in group II at the end of first postoperative week.At the first postoperative day, foreign body sensation was seen in 44% of patients in group I and 69% in group II which reduced to 10% in group I and 28% in group II at the end of first postoperative week.Subconjunctival hemorrhage was present in one patient in group I and in three patients in group II. Displacement of graft was present in three patients in group I. CONCLUSION:This study showed that the incidence of postoperative symptoms like pain, foreign body sensation and lacrimation were seen among fewer patients in the fibrin glue as compared to the autologous blood group.Though the displacement of graft was higher in fibrin glue.The main disadvantage of fibrin glue is its high cost. Autologous blood is a cost effective alternative and is the most commonly used method.