Conjunctival Limbal Autograft With Fibrin Glue With Mitomycin-C in Managing Recurrent Pterygium
R. Bakshi, C. Khurana, H. Gupta, M.S.Sachdev
Centre for Sight,New Delhi, India.
The authors have no financial interest in the subject matter of this e-poster.
Aim
• To evaluate the results of Conjunctival Limbal Autograft(CLAU) with Fibrin glue with Mitomycin-C (MMC)in the management of Recurrent Pterygium.
Methods
• Retrospective review of 12 eyes of 12 patients presenting with recurrent pterygium was done.
• All patients had previous failed pterygium surgeries in the form of recurrences.
Methods
• Surgical technique included Pterygium excision, followed by application of intra-operative 0.02% Mitomycin-C for 30 seconds, followed by sutureless Conjunctival Limbal Autograft (CLAU) which was affixed with Fibrin glue.
• Conjunctival-limbal autograft was measured and harvested from the superotemporal bulbar conjunctiva.
• If the superotemporal bulbar conjunctiva was unhealthy and scarred, the graft was harvested from the inferior bulbar conjunctiva or the superotemporal bulbar conjunctiva of the contralateral eye.
Results
• Mean age of the patients was 40.08+/-16.52 years.
• Mean follow up period was 10.5+/-3.6 months. • Mean number of previous surgeries were 1.33+/-
0.65 (range 1-3). • All patients were symptomatically comfortable in
the immediate post-operative period. • Post-operative surface inflammation was
minimal.
Results
• No major post-operative complications were noted.
• One patient (8.3%) had a small granuloma at the recipient bed whereas
• One had retraction (8.3%) of the autograft at day one.
• There were no recurrences noted in any of the patients during the follow up period. (0%)
Recurrent Pterygium
Pterygium Excision with Conjunctival limbal Autograft + MMC + Fibrin Glue
10 days post-operative
Recurrent Pterygium
Pterygium Excision with Conjunctival limbalAutograft + MMC + Fibrin Glue
1 week post-operative
Discussion
• The use of conjunctival-limbal autograft is associated with an extremely low recurrence rate (0-5%)1-4
• Conjunctival autograft with Fibrin glue is associated with decreased surgical time, a quieter eye postoperatively, and better patient comfort.
• Fibrin glue is a biological tissue adhesive which imitates the final stages of the coagulation cascade when a solution of human fibrinogen is activated by thrombin, which are respectively the two components of the glue.
• The use of intraoperative Mitomycin C 0.02% further
helps in reducing the postoperative recurrence and scarring.5
Conclusions
• CLAU with Fibrin glue with MMC is an effective technique in the management of Recurrent Pterygium.
References
1. Sarnicola V et al, Recurrence rate using fibrin glue-assisted ipsilateral conjunctival autograft in pterygium surgery: 2-year follow-up. Cornea. 2010 Nov;29(11):1211-4
2. Malik VK et al,Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft. Saudi Med J. 2010 Dec;31(12):1326-30
3. Tan et al,Assessment of fibrin glue in pterygium surgery. Cornea. 2010 Jan;29(1):1-4
4. Farid M et al,Pterygium recurrence after excision with conjunctival
autograft: a comparison of fibrin tissue adhesive to absorbable sutures. Cornea. 2009 Jan;28(1):43-5
5. Koranvi G et al, Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four-year follow-up. Acta Ophthalmol. 2010 May 28. doi: 10.1111/j.1755-3768.2010.01936