Pterygium excision with amniotic graft: short-term complications – is it better wet or better dry?

Poster Details

First Author: SanjeevNath USA

Co Author(s):    Hossain Sheikh   Jerome Sherman   Rishi Mohan   Moolchand Ambwani   Anjali Nath   Gautam Upadhya

Abstract Details

Purpose:

To report on our initial short term (60 day) experience with early post-op complications in a consecutive series of 20 cases of pterygium excision performed with an ambiodry (IOP) graft and 20 cases with a wet (BIOTISSUE) amniograft using tisseal tissue glue in a sutureless technique. We compared the vascularization, dislocation and secondary surgical procedures in 20 cases of ambiodry grafts and compared with a group of 20 cases of wet amniotic graft.

Setting:

: A clinical private practice setting/ A retrospective study.

Methods:

20 consecutive cases of amniograft (BIOTISSUE) were performed under sub tenon lidocaine 2% with epinephrine anesthesia after a pterygium excision was performed using a standardised technique and a wet amniograft was placed on the cornea and slid over the bare sclera using fibrin tissue glue along with a bandage Contact lens and an eye patch (no pressure patch) A similar technique had been used with the ambiodry graft which was directly placed on the scleral bed covered by tissue glue/ tisseal. but without the bandage contact lens. After a 2 minute wait, a blink test was performed to confirm the stable adhesion of the graft. Pressure patch after instillation of an antibiotic/steroid ointment was only performed in the dry group. Patients were examined day 1 or 2, day 5or 8 and then week 2,4, & 8 and additional days in between as clinically deemed necessary. Surgery was uncomplicated in all cases and no intra operative occurrences were identified in either group. A bandage contact lens was used only in the wet group.

Results:

Post op regimen (antibiotic, steroid and lubricating drops) was similar in both groups.. Graft edema, elevation, position and displacement as well as conjunctival edge vascularity were monitored in all cases. 3 cases of graft edema were seen in the dry group. None were noted in the wet group. All the eyes with graft edema were managed by making full thickness incisions with vannas scissors thru the graft. This was performed at the slit lamp under topical anesthesia using Q-tips with rolling movements to milk out the underlying fluid. These eyes received increased dosing of steroids until the edema resolved and failed to re-accumulate. This occurred in most cases within 2 weeks. 1 eye had a recurrent accumulation which was handled similarly to a primary accumulation. There were 4 re-positionings in the dry group. All of these were easily performed at the slit lamp under topical tetracaine anesthesia. Vascularisation at the nasal edge was monitored as healing progressed. This was greater in the dry than in the wet group. Eyes with graft edema were more likely to exhibit this. Steroid use was continued longer in this group.

Conclusions:

The wet amniograft was significantly better tolerated than the dry ambiodry graft. The wet graft had no dislocations or sub graft fluid accumulation in this small initial consecutive series of cases performed by an experienced surgeon. Early vascularisation with possible increase in recurrence risk was noted in more eyes in the dry group compared to the wet group. However there were no cases of frank recurrence in this short follow up in either wet or dry groups. Since a bandage contact lens was only used in the wet group, it is unclear whether the use of one in the dry group may have prevented FINANCIAL INTEREST: NONE