Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

Dong Yub Kwak; Jin Kee Lee; Dae Jin Park

doi:10.3341/jkos.2008.49.2.213

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Kwak, Lee, and Park: Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

Original Article

J Korean Ophthalmol Soc 2008;49(2):213-221.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.213

Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

Dong Yub Kwak, M.D., Jin Kee Lee, M.D., Dae Jin Park, M.D.

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Dae Jin Park, M.D., Department of Ophthalmology, Daegu Fatima Hospital #576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel: 82-53-940-7140, Fax: 82-53-940-7149, E-mail: djoph2540@yahoo.co.kr

Received 31 May 2007 Accepted 31 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the efficacy and safety of fibrin glue and sutures for amniotic membrane transplantation after wide excision of primary pterygium.

Methods

Forty-three eyes of 37 patients underwent amniotic membrane transplantation for primary pterygium with a minimum follow-up period of six months. Twenty-three eyes of 18 patients underwent surgery with fibrin glue and 20 eyes of 19 patients underwent surgery with sutures. Recurrence rates, complications, operating time were evaluated.

Results

With a minimum of six-month of follow-up, fibrovascular tissue in the excised area, not invading the cornea (conjunctival recurrence), was noted in four eyes (17.4%) and fibrovascular tissue invading the cornea (corneal recurrence) was noted in two eyes (8.7%) in the fibrin glue group. Conjunctival recurrence was noted in five eyes (25%) and corneal recurrence was noted in one eye (5%) in the suture group. There was no significant difference in the recurrence rates between the two groups. Mean operating time in the fibrin glue group (25.2±3.5 minutes) was significantly shorter than in the suture group (40.5±3.6 minutes) (p=0.001, Students t-test). Complications included sub-amniotic membrane hemorrhage in three eyes (13%), and granuloma in one eye (4.3%) in the fibrin glue group, sub-amniotic membrane hemorrhage in four eyes (20%), granuloma in three eyes (15%), and wound dehiscence in one eye (5%) in the suture group.

Conclusions

Using fibrin glue instead of sutures in amniotic membrane transplantation after wide excision of pterygium can be considered an effective treatment with shorter operating time and fewer complications, although there is no significant difference in recurrence rates.

Keywords: Amniotic membrane transplantation, Fibrin glue, Pterygium, Recurrence rates.

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Figure 1.

Classification of pterygium. (A) Grade T1 (atrophic) episcleral vessels are unobscured. (B) Grade T2 (intermediate) episcleral vessels are partially obscured. (C) Grade T3 (fleshy) episcleral vessels are totally obscured.

Figure 2.

Grading of recurrence after pterygium surgery. (A) Grade 0, normal appearance of the operated site. (B) Grade 1, fine episcleral vessels in the excised area. (C) Grade 2, fibrovascular tissue in the excised area, reaching to the limbus, but not invading the cornea (conjunctival recurrence). (D) Grade 3, fibrovascular tissue invading the cornea (corneal recurrence).

Figure 3.

Procedure to perform amniotic membrane transplantation using fibrin glue after wide excision of pterygium. (A) 1:1,000 epinephrin was dropped. (B) episcleral traction sutures were placed. (C) excision and blunt dissection of pterygium from the cornea and sclera by using conjunctival scissors. (D) remnant pterygium of the cornea was dissected off by corneal forceps.(E) wide excision of the subconjunctival Tenon's tissue was done by the Ellman cautery. (F) amniotic membrane is peeled off the carrier paper and spread over the cornea. (G) a drop of thrombin solution on bare sclera. (H) a dorp of fibrinogen solution on the amniotic membrane. (I) the amniotic membrane was then immediately transferred onto the bare sclera. (J) smoothering of the amniotic membrane was done by a muscle hook. (K) the amniotic membrane was sutured to the episclera and conjuctiva to facilitate regeneration of the conjunctiva over the amniotic membrane. (L) triamcinolon was injected.

Figure 4.

(A) The right eye before surgery. There is a large and fleshy primary pterygium occluding the visual axis. (B-C) At 1 day after surgery. The amniotic membrane area is transparent and nonvascularized B. Note transplanted amniotic membrane stained by fluorescein C. (D-E) At 3 weeks after surgery. The surgical wound is healed D and complete epithelization is done under fluorescein staining E. (F) At 6 months after surgery. There is a smooth and quiet conjunctival surface at the operated site.

Figure 5.

Postoperative complications. (A) sub-amniotic membrane hemorrhage. (B) granuloma at the operated site.

Table 1.

Demographic datas between fibrin glue group and suture group

	Fibrin glue (23 eyes)	Suture (20 eyes)	p-value
Age (years) (Mean±SD^*)	60.5±11.7	57.1±13.1	0.41^†
Sex (Male: Female)	10:8	6:13	0.14^‡
Follow-up (weeks) (Mean±SD^*)	28.4±2.8	26.9±2.6	0.10^†
Grade T2: Grade T3 (eyes)	9:14	7:13

^* SD=standard deviation

^† Measured by Student's t-test

^‡ Measured by chi-square test.

Table 2.

Comparison of recurrence rates between fibrin glue group and suture group

	Fibrin glue		Suture
	Grade T2	Grade T3	Grade T2	Trade T3
G2 (conjunctival recurrence)	0	4 eyes	1 eye	4 eyes
G3 (corneal recurrence)	0	2 eyes	0	1 eye
Recurrence rates
Between T2 and T3	0/9 (0%)^*	6/14 (42.9%)^*	1/7 (14.3%)^†	5/13 (38.5%)^†
Total	6/23 (26.1%)^‡		6/20 (30%)^‡

^* Chi-square test, p-value=0.048

^† Chi-square test, p-value=0.354

^‡ Chi-square test, p-value=1.000.

Table 3.

Comparison of operating time and number of sutures

	Fibrin glue	Suture	p-value
Operating time (minutes) (Mean±SD^*)	25.2±3.5	40.5±3.6	p=0.001^†
Number of sutures (Mean±SD^*)	3.8±0.6	13.8±1.3	p=0.000^†

^* SD=standard deviation

^† Measured by Student's t-test.

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