Korean J Ophthalmol.  2008 Sep;22(3):147-154. 10.3341/kjo.2008.22.3.147.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

• Kim HH
• Mun HJ
• Park YJ
• Lee KW
• Shin JP

• KMID: 1070748
• DOI: http://doi.org/10.3341/kjo.2008.22.3.147

Abstract

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Keyword

Conjunctivolimbal autograft; Fibrin bioadhesive; Pterygium excision

MeSH Terms

Adult
Aged
Aged, 80 and over
Conjunctiva/*transplantation
Female
Fibrin Tissue Adhesive/*therapeutic use
Follow-Up Studies
Humans
*Limbus Corneae
Male
Middle Aged
Postoperative Complications
Pterygium/*surgery
Tissue Adhesives/*therapeutic use
Transplantation, Autologous

Figure

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  Fig. 1 Surgical procedures of conjunctivolimbal autograft using a fibrin adhesive (Tissucol Duo Quick®) in pterygium surgery. (A) Pre-operative fleshy nasal pterygium. (B) The pterygium head was excised, the conjunctiva allowed to retract, and the subconjunctival fibrovascular tissue excised en bloc. (C) Superior conjunctivolimbal autograft was flipped over the cornea and the limbal attachment, and them the head of the palisades of Vogt was cleaned with a blade. (D) Conjunctivolimbal autograft kept placed over the cornea. The graft was rotated toward the defect site, spreading the conjunctiva out, being mindful of orienting the limbal stem cell population toward the limbus. (E) The fibrin glue was applied over the bare sclera and conjunctivolimbal autograft; A drop of fibrinogen solution was placed on the bare sclera and a drop of thrombin solution was placed conjunctivolimbal autograft. (F) Conjunctivolimbal autograft spread over the bare sclera with the edges bonded to the surrounding health conjunctiva by using McPherson forceps.

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  Fig. 2 The photograph anterior segment on day 1 after pterygium excision and superior conjunctivolimbal autograft attached with fibrin glue. Note the relatively low inflammatory appearance of the eye, well-positioned graft and reestablishment of the normal limbal architecture.

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  Fig. 3 Left column (A, B, C, D, E, F): Images of preoperative fleshy grade 3 nasal primary pterygium. Right column (G, H, I, J, K, L): Images of the conjuntivolimbal autograft of the same patients on 12 weeks after surgery. Well-positioned graft and reestablishment of the normal limbal architecture are observed with no signs of recurrence in all subjects.

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  Fig. 4 (A) Mild shrinkage (between arrows) of the conjunctivolimbal autograft and recipient conjunctiva was noted 2 weeks after surgery: Secondary epithelialization and spontaneous closure of the wound gap occurred in one week. (B) Transient edema (arrows) of conjunctivolimbal autograft 2 weeks after surgery: Spontaneous resolution occurred in one month.

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