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Salina Teja, Sophie Boucher, Kashif Baig; Comparison of fibrin glue and autologous blood for conjunctival autograft fixation in pterygium surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3105.
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Our purpose is to investigate the use of a novel technique, graft fixation with autologous blood, by comparing its anatomic and visual outcomes to those obtained with fibrin glue in pterygium excision surgery.
This is a retrospective comparative case series of patients with a primary nasal pterygium who underwent excision. All patients had a conjunctival autograft from the superior bulbar conjunctiva to cover the scleral bed. 17 patients had fixation of the autograft with autologous blood (AB) and 17 patients had fixation with fibrin glue (FG). Data was collected up to 6-months post operatively and included; surgical cost and time, conjunctival graft stability and healing, visual acuity and pterygium recurrence. Outcomes were compared between the two groups and assessed for statistical significance with a paired student t test.
Of our 34 patients, 15 were female and 18 were male with a mean age of 52. The mean size of conjunctival autograft was 36mm2 in the AB group and 42mm2 in the FG group. There were no intra-operative complications in either group. Surgical costs differed in each group: the FG group incurred the cost of the fibrin glue whereas the AB group had the additional costs associated with an extra 15 minutes of procedure time. At 1-month post-operatively, 4 patients in the AB group had lost their graft compared to zero in the FG group, showing greater stability in the FG group. Mild graft displacement was seen in 3 patients in each group. The visual acuity was stable in both groups. There was no incidence of pterygium recurrence in either group. 6-month follow up outcomes will be analyzed by February 2013.
Pterygium recurrence rates vary due to many factors including surgical technique. The conjunctival autograft fixated with autologous blood has been shown to be safe and effective but its role is not well established. The fibrin glue technique is widely used but poses a risk of hypersensitivity reactions, discomfort, scarring and infection. Our preliminary results show that fixation with autologous blood produces similar visual and pterygium recurrence outcomes to fibrin glue fixation, however seems to have less stable grafts at follow up. Our comparison of the efficacy and stability of the conjunctival autograft between the two techniques at 6 month follow up will help to further establish the role of autologous blood in pterygium surgery.
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