Autologous blood as tissue adhesive for conjunctival autograft in primary nasal pterygium surgery

Abstract

Introduction. Pterygium is defined as a triangular fibrovascular growth of connective tissue covered with conjunctival epithelium which extends over the corneal surface from the corneo-scleral margin. Surgical removal is the mainstay treatment with autologous blood used as tissue adhesive to prevent recurrences and scarring. Objectives. To describe a simple method of conjunctival autograft adherence during pterygium surgery, and assess the efficacy of securing limbal conjunctival autograft using the patient’s own blood. Materials and method. This is a prospective interventional study conducted from June 2017 – March 2018 in the department of Ophthalmology at the Government Medical College in Nizamabad, India. After pterygium excision, conjunctival autograft was placed over the sclera bed after attaining haemostasis. Graft adherence was examined 20 minutes after surgery. Results. A total 100 patients with pterygium underwent pterygium excision with conjunctival autograft surgery using autologous blood. There were 45 female and 55 male patients who had primary nasal pterygium, and 65 patients with progressive pterygium and 35 patients with non-progressive pterygium. Post-operative complications like granuloma had developed in 3 (3%) patients, 10 (10%) patients had conjunctival haemorrhage, 5 (5%) patients had developed graft dehiscence and retraction. 4 (4%) patients had graft oedema and 2 (2%) patients developed recurrence of pterygium after 3 months. Improvement of visual acuity was observed in 10 patients. Cosmesis was good in all patients Conclusions. It could be concluded from this study that using autologous blood as a tissue adhesive for graft fixation is a useful alternative. This procedure is safe, effective, and economical, with less discomfort and more patient satisfaction. Risks associated with fibrin glue and suture related problems are avoided.