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Comparative evaluation of conjunctival autograft characteristics in pterygium surgery using autologous blood versus fibrin glue

Session Details

Session Title: Cornea

Session Date/Time: Sunday 16/02/2014 | 08:30-11:00

Paper Time: 08:48

Venue: Linhart Hall (Level -2)

First Author: : TusharAgarwal INDIA

Co Author(s): :    Kanhaiya Mittal   Shikha M.   Sudershan Khokhar        

Abstract Details

Purpose:

To compare the effect on post-operative graft characteristics using patient’s autologous in situ blood and the standard fibrin glue assisted conjunctival autograft adhesion in cases of Pterygium excision.

Setting:

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi

Methods:

This is a case control study comparing Group I consisting of 20 consecutive eyes which underwent pterygium excision and conjunctival autograft with autologous in situ blood coagulum and Group II comprising of historical case controls (20 eyes) who had undergone pterygium excision with fibrin glue assisted conjunctival autograft by the same surgeon. Patients were followed up on day 1, day 7, 1, 3 and 6 months thereafter. Primary outcome measure was to compare the graft stability at 6 months and secondary outcome measures were assessment of graft inflammation, sub-conjunctival hemorrhage and underlying corneal clarity. Srinivasan grading method was employed for these purposes.

Results:

The two groups did not differ from each other with respect to baseline characteristics viz. mean age (p=0.4), gender (p=0.7), preoperative UCVA (p=0.3), BCVA (p=0.14), spherical equivalent (p=0.06), mean astigmatism (p=0.8), tear function tests like tear break up time, tear film meniscus height, Schirmer I and II (p=0.08, 0.26, 0.6, 0.14 respectively) and pterygium height and width (p=0.12 and 0.5). Initial graft stability was better for group II till 1 month (p=0.001) but achieved graft stability equivalent to group I at 6 months follow up. Median graft inflammation score was significantly more for group II at day 1 and 7 (p=0.04 and 0.007 respectively. However no significant difference between the two groups was observed in relation to underlying corneal clarity and sub-conjunctival hemorrhage.

Conclusions:

Pterygium excision and conjunctival autograft with autologous blood is a viable surgical option for management of primary pterygium. In comparison to conjunctival autograft with fibrin glue, the graft stability is less with blood assisted graft adhesion till 1 month follow up, however subsequently it equalizes with that of glue assisted conjunctival autograft. Graft inflammation is initially less with autologous blood. Though, glue assisted conjunctival autograft remains the gold standard for management of primary pterygium, autologous blood may be useful in cases where reducing patient cost is a major concern without compromising the efficacy of the procedure. In addition, the risk of serum transmitted infections is eliminated with this approach. FINANCIAL INTEREST: NONE