Conjunctival Limbal Autograft With Fibrin Glue With Mitomycin-C in Managing Recurrent Pterygium

R. Bakshi, C. Khurana, H. Gupta, M.S.Sachdev

Centre for Sight,New Delhi, India.

The authors have no financial interest in the subject matter of this e-poster.

Aim

• To evaluate the results of Conjunctival Limbal Autograft(CLAU) with Fibrin glue with Mitomycin-C (MMC)in the management of Recurrent Pterygium.

Methods

• Retrospective review of 12 eyes of 12 patients presenting with recurrent pterygium was done.

• All patients had previous failed pterygium surgeries in the form of recurrences.

Methods

• Surgical technique included Pterygium excision, followed by application of intra-operative 0.02% Mitomycin-C for 30 seconds, followed by sutureless Conjunctival Limbal Autograft (CLAU) which was affixed with Fibrin glue.

• Conjunctival-limbal autograft was measured and harvested from the superotemporal bulbar conjunctiva.

• If the superotemporal bulbar conjunctiva was unhealthy and scarred, the graft was harvested from the inferior bulbar conjunctiva or the superotemporal bulbar conjunctiva of the contralateral eye.

Surgical technique of Pterygium Excision with conjunctival autograft with Fibrin Glue

Results

• Mean age of the patients was 40.08+/-16.52 years.

• Mean follow up period was 10.5+/-3.6 months. • Mean number of previous surgeries were 1.33+/-

0.65 (range 1-3). • All patients were symptomatically comfortable in

the immediate post-operative period. • Post-operative surface inflammation was

minimal.

Results

• No major post-operative complications were noted.

• One patient (8.3%) had a small granuloma at the recipient bed whereas

• One had retraction (8.3%) of the autograft at day one.

• There were no recurrences noted in any of the patients during the follow up period. (0%)

Recurrent Pterygium

Pterygium Excision with Conjunctival limbal Autograft + MMC + Fibrin Glue

10 days post-operative

Recurrent Pterygium

Pterygium Excision with Conjunctival limbalAutograft + MMC + Fibrin Glue

1 week post-operative

Discussion

• The use of conjunctival-limbal autograft is associated with an extremely low recurrence rate (0-5%)1-4

• Conjunctival autograft with Fibrin glue is associated with decreased surgical time, a quieter eye postoperatively, and better patient comfort.

• Fibrin glue is a biological tissue adhesive which imitates the final stages of the coagulation cascade when a solution of human fibrinogen is activated by thrombin, which are respectively the two components of the glue.

• The use of intraoperative Mitomycin C 0.02% further

helps in reducing the postoperative recurrence and scarring.5

Conclusions

• CLAU with Fibrin glue with MMC is an effective technique in the management of Recurrent Pterygium.

References

1. Sarnicola V et al, Recurrence rate using fibrin glue-assisted ipsilateral conjunctival autograft in pterygium surgery: 2-year follow-up. Cornea. 2010 Nov;29(11):1211-4

2. Malik VK et al,Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft. Saudi Med J. 2010 Dec;31(12):1326-30

3. Tan et al,Assessment of fibrin glue in pterygium surgery. Cornea. 2010 Jan;29(1):1-4

4. Farid M et al,Pterygium recurrence after excision with conjunctival

autograft: a comparison of fibrin tissue adhesive to absorbable sutures. Cornea. 2009 Jan;28(1):43-5

5. Koranvi G et al, Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four-year follow-up. Acta Ophthalmol. 2010 May 28. doi: 10.1111/j.1755-3768.2010.01936