First Author: J.Martins PORTUGAL
Co Author(s): P. Barros B. Vieira J. Serino J. Neves Martins
Purpose:
Conjunctival-Limbal Autograft has been successfully used for the treatment of primary and recurrent pterygium. Our purpose was to compare the objective outcomes of fibrin glue conjunctival autografts (FGCA) and fibrin glue extended conjuntival autografts (FGECA) a modified technique in pterygium surgery .
Setting:
: Department of Ophthalmology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal.
Methods:
surgery at Pedro Hispano Hospital, between 2009 and earlier 2011. The minimum follow-up was 6 months. The patients were randomly divided, and subjected to FGCA - group 1 or FGECA - group 2. Objective outcome was compared on the basis of recurrence rate (morphologically classified as: Grade 0 - no limbal changes; Grade 1 - neovascularization above 1mm and Grade 2 - pseudopterygium formation), mean surgical time, cosmesis, and safety of the procedure, while subjective outcomes were assessed on the basis of postoperative symptoms. In most of the studies describing these procedures, an inadequate length of follow up (<1 year) or a high percentage of patients lost to follow up has led to an underestimate of the true rate of recurrence. In addition, a recurrence is usually defined as the movement of fibrovascular tissue across the limbus. A “conjunctival recurrence,” where injected fibrovascular tissue advances to the limbus but not over it, is not included as a complication. The latter result, however, is often cosmetically poor . Cosmesis has to be considered if results are to be understood in terms of patient satisfaction.
Results:
The time elapsed between surgery and our evaluation ranged from 6-30 months. Mean surgical time with the two procedures was the same approximately. Recurrence rate (grade 2) was 0,6 % group A and 0,8% group B, mainly due to errors in surgical technique learning. However cosmetic outcome was better in group B (recurrence rate 0,1% grade 0). This type of technique requires loco- regional anesthesia, unlike the previous technique.
Conclusions:
Extented Conjunctival-limbal autograft described initially by Lawrence W. Hirst and modified with the use of fibrin glue, is a major modification of existing conjunctival autograft techniques and distinguishes as the best technique in the management of primary or recurrent pterygium. Appears to be a safe and effective procedure with reduced surgical time, with better cosmesis and final result than the inicial one and maintain a lower recurrence and complication rate; however, it is also lengthy, complex, and requires a full peri- or retrobulbar anesthetic. In addition, there is frequently a short period of postoperative pain and diplopia.
Financial Disclosure:
None
Financial Disclosure:
No
