The Efficacy Of Autologus Fibrin (Blood) Versus Sutures In Attaching Conjunctival Autograft After Pterygium Surgery-A One Year Randomized Clinical Trial

Abstract

Background and objectives Pterygium is a triangular sub epithelial in growth of degenerative bulbar conjunctival tissue over limbus onto cornea.The prevalence in India is 2.4-30%. Surgery is always considered the treatment of choice for pterygium. Age old procedures included simple excision (bare sclera) technique which was associated with high rate of reccurence (80%) which would be more aggressive than the primary lesion. So, pterygium excision with limbal stem cell autograft is considered standard procedure now which has a proven least reccurrance rate. Sutures have been used traditionally to adhere graft in position but it requires surgical expertise, a longer operating time, post operative discomfort and local complications like scarring, infection, foreign body granuloma etc. Later fibrin glue was used in place of sutures which reduced operating time and post operative complications associated with sutures but since it is a plasma derived product it may produce possible hypersensitivity reactions, a risk of transmission of viral diseases and the availability and economic considerations are not in the reach to all sections of population. Since it is a new approach and there is no literature evidence available to test the efficacy of conventional method using sutures with the new method using autologus fibrin(blood) in adhering graft after pterygium surgery as only one case series is done in Indian set up this present study is planned. Methods Patients with primary pterygia were enrolled into study after taking an informed and written consent. The demographic data of the patients was noted in predesigned proforma by the investigator. After taking history and preliminary ophthalmological examination pterygia were graded according to grading system developed by Tan & Associates as Grade1(atrophic) with episcleral vessels under body of pterygium not obscured and clearly distinguishable, Grade 3(Fleshy)episcleral vessels totally obscured or Grade 2(between 1 & 3). Subjects were then randomized into 2 groups according to computer generated randomized charts as follows, Group 1—Conjunctival autograft with autologus fibrin(blood). Group 2—Conjunctival autograft with sutures. PROCEDURE/INTERVENTION: Pterygium tissue was excised and bare sclera replaced by conjunctival autograft. In Group 1 autograft was adhered to underlying episcleral bed by autologus fibrin (patient’s own blood from limbal vessels). In Group 2 the graft was adhered by 8-0 vicryl sutures. Patients were examined on 1st post op. day, then after 1 week, 6 weeks & 3 months after surgery. Results In this study the mean age in Group 1 was 50.5 +/- 14.81 years with range being 30 to 80 years, and in Group 2 the mean age was 48.9 +/- 13.23 years with range being 30 to 72 years. The mean operative time in group 1 was less compared to group 2 ( 22.1+/- 5.43 vs 25.2 +/- 2.61 minutes) with range in group 1 being 15 to 33 minutes and in group 2 being 18 to 30 minutes. Conclusion and interpretation The present study showed better efficacy of autologus fibrin adhesive in conjunctival autografting among the patients undergoing pterygium excision, in terms of pain, foreign body sensation, lacrimation and discomfort during blinking. Also, it significantly reduced the surgical time with fewer post operative complications.