Sutureless, Glue-less Conjunctival Autograft versus Conjunctival Autograft with Sutures for Primary, Advanced Pterygia: An Interventional Pilot study

Abstract

Introduction: Conjunctival Autograft (CAG) in pterygium surgery can be attached by sutures or fibrin glue or autologous in situ blood coagulum. Recurrence rate and other parameters related to pterygium surgery between CAG with sutures and autologous in situ blood coagulum have not been compared uniformly in advanced pterygia alone.

Aim: To compare and evaluate the outcome of sutureless, glue-less CAG with autologous in situ blood coagulum versus CAG with sutures for primary, advanced pterygium.

Materials and methods: Thirty eyes of 30 patients with primary, nasal, advanced, Grade 3 pterygia (as per Tan et al's., classification) were randomized into Group 1 (n=15) (sutureless, glue-less CAG with autologous in situ blood coagulum) and Group 2 (n=15) (conjunctival autograft with 8-0 vicryl sutures) as a pilot study. The outcome parameters evaluated were graft stability and symptoms of pain, foreign body sensation and watering at day 1, day 7, day 14, one month, three months and six months and recurrence at six months.

Results: The mean age in the study was 44.77±13.74 years. Overall, Group 1 had better scores in symptom parameters than Group 2 (p<0.05). Graft stability was better in Group 2 (p<0.05). In Group 1, 3 (20%) patients had one side displacement and 3 (20%) patients had full displacement of graft. At six months, 4 (26.6%) patients in Group 1 had recurrence whereas in Group 2, 5 patients (33.3%) had recurrence (p=0.446).

Conclusion: In primary, advanced pterygia, sutureless, glue-less pterygium surgery with autologous in situ blood coagulum was better in symptom scores but graft stability was better in the suture group. Sutureless, glue-less pterygium surgery with autologous in situ blood coagulum was unpredictable in graft stability. There was no statistically significant difference in the recurrence rate between the two groups.

Keywords: Advanced pterygium; Autologous in situ blood coagulum; Glue-less pterygium surgery.

[Table/Fig-1]:

Preoperative photograph of a case of primary, grade 3, nasal pterygium in the left eye of Group 1.

[Table/Fig-2]:

Postoperative appearance following pterygium surgery using CAG with autologous in situ blood coagulum in the same patient on day 14.

[Table/Fig-3]:

Postoperative appearance following pterygium surgery using CAG with autologous in situ blood coagulum in the same patient on day 30.

[Table/Fig-4]:

Preoperative photograph of a case of primary, grade 3, nasal pterygium in the right eye of Group 2.

[Table/Fig-5]:

Postoperative appearance following pterygium surgery using CAG with sutures in the same patient on day 14.

[Table/Fig-6]:

Postoperative appearance following pterygium surgery using CAG with sutures in the same patient on day 30.

[Table/Fig-7]:

Line graphs showing comparison of foreign body sensation scores on a five-point scale in the two groups, wherein Group 2 has higher foreign body sensation scores as compared to Group 1 throughout the study period, meaning Group 2 has more foreign body sensations.

[Table/Fig-8]:

Line graphs showing comparison of pain scores on a five-point scale in the two groups. From day 1 till day 30, Group 2 has higher pain scores than Group 1. Subsequently, both the groups have equal pain scores.

[Table/Fig-9]:

Line graphs showing comparison of epiphora scores on a five-point scale in the two groups., From day 1 till day 30, Group 2 has higher epiphora scores than Group 2. Subsequently, both the groups have almost equal scores.

[Table/Fig-10]:

Line graphs showing comparison of graft stability scores on a five-point scale in the two groups. Group 2 has lower scores than Group 1 throughout the study period, meaning Group 2 has more graft stability, since lower score means more stability as per the grading system.