Clinical Outcomes after Use of Fibrin Glue Using a Modified Mini-flap Technique for Pterygium Surgery

Kyoung Kim Moon; MD Ikhyun Jun,; MD Tae-im Kim,; MD Eung Kweon Kim,; MD Kyoung Yul Seo,

doi:10.3341/jkos.2017.58.7.797

Journal List > J Korean Ophthalmol Soc > v.58(7) > 1010809

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Moon, Ikhyun Jun,, Tae-im Kim,, Eung Kweon Kim,, and Kyoung Yul Seo,: Clinical Outcomes after Use of Fibrin Glue Using a Modified Mini-flap Technique for Pterygium Surgery

Original Article

J Korean Ophthalmol Soc 2017;58(7):797-803.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.797

Clinical Outcomes after Use of Fibrin Glue Using a Modified Mini-flap Technique for Pterygium Surgery

Kyoung Kim Moon, M.D.¹, MD Ikhyun Jun,, PhD¹, MD Tae-im Kim,, PhD^1,², MD Eung Kweon Kim,, PhD^1,², MD Kyoung Yul Seo,, PhD^1,

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Kyoung Yul Seo, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: SEOKY@yuhs.ac

* This study was presented as a narration at the 116th Annual Meeting of the Korean Ophthalmological Society 2016.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 30 March 20173 May 2017 Accepted 22 June 2017

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 analyze the long-term clinical outcomes after use of fibrin glue using a modified mini-flap technique for pterygium surgery.

Methods

This study is a retrospective, clinical outcome study of 148 subjects that underwent the modified mini-flap technique with fibrin glue from January 2014 to August 2015. We analyzed the recurrence rate and surgical time of modified mini-flap sur-gery with fibrin glue. We also analyzed associating factors between the recurrence group and non-recurrence group who under-went the same surgery technique.

Results

Mean age was 60.2 ± 1.1 (ranging from 29 to 86) years, and mean surgical time was 11.8 ± 5.8 (ranging from 5 to 36) minutes. The recurrence rate of pterygium patients who underwent the fibrin glue using a modified mini-flap technique was 4.0% (6/148), and the re-operation rate was 0.6% (1/148). From the comparison of associating factors between recurred and non-re-curred groups, the recurred group was younger, had more severe disease, and had a higher rate of bilaterality than the non-re-curred group (p < 0.05).

Conclusions

The new approach using fibrin glue with a modified mini-flap technique shows a low recurrence rate compared to the other type of pterygium surgery. The use of fibrin glue shortened operation time and decreased patient discomfort due to few-er remnant sutures. Fibrin glue use in a modified mini-flap technique can be considered as a feasible surgical option for ptery-gium patients.

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Keywords: Fibrin glue, Mini-flap, Pterygium, Recurrence

References

1. Youngson RM. Recurrence of pterygium after excision. Br J Ophthalmol. 1972; 56:120–5.

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7. Tsim NC, Young AL, Jhanji V. . Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: a long-term follow-up study. Br J Ophthalmol. 2015; 99:1396–400.

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Figure 1.

Modified mini-flap technique with Fibrin glue. (A) Create conjunctival window on pterygium neck. (B) Remove ptery-gium from head to body. (C) Conjunctival relaxing incision for preparing a flap. (D) A conjunctiva-sclera-conjunctiva suture at 0.4 mm apart from corneolimbal margin. (E) A conjunctiva-sclera-conjunctiva suture at inner-most part of a conjunctival flap (black-ar-row). (F) Apply fibrinogen (black-arrow) under conjunctival flap and thrombin (white-arrow) above conjunctival flap. (G) Additional multiple conjunctival sutures (black-arrows) in Mini-flap technique without Fibrin glue.

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Figure 2.

Representative pre and post operative pictures of Fibrin glue using modified Mini-Flap technique for pterygium surgery. (A) Preoperative in patient received fibrin glue using modified mini-flap technique. (B) Postoperative 1 day in patient received fibrin glue using modified mini-flap technique. (C) Preoperative in severe pterygium case patient received fibrin glue using modified mini-flap technique. (D) Postoperative 1 month in severe pterygium case patient received fibrin glue using modified mini-flap technique.

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Table 1.

Demographic characteristics of patients

Characteristics	Value
Number of eyes	148 eyes
Age (years) (range)	60.2 ± 1.1 (29-86)
Sex (male/female)	80/68
Surgical time^* (minutes) (range)	11.8 ± 5.8 (5-36)
Severe case (n, %)	53 (35.8)
Previously operated case (n, %)	21 (14.2)
Bilateral case (n, %)	64 (43.2)

Values are presented as mean ± SD (range) or (n, %) unless other-wise indicated.

^* Definition of surgical time: duration from the placement of lid speculum to its removal at the end of surgery.

Table 2.

Recurrent periods of fibrin glue using mini-flap technique in pterygium surgery

Period	Rate (number)
Post-op. 1 week	0.7% (1 case)
Post-op. 1 month	0.0% (0 case)
Post-op. 3 months	2.7% (4 cases)
Post-op. over 3 months	0.7% (1 case)

Post-op = postoperative.

Table 3.

Differences between recurrence and non-recurrence cases of fibrin glue using mini-flap technique in pterygium surgery

	Non-recurrence (142 cases)	Recurrence (6 cases)	p-value
Age (years)	61.02 ± 12.20	41.17 ± 15.10	0.023^*
Sex (male/female)	78/64	2/4	0.515^†
Severe case (case, %)	48, 33.8%	5, 83.3%	0.013^†
Previously operated case (case, %)	20, 14.1%	1, 16.7%	0.860^†
Bilaterality (case, %)	59, 41.5%	5, 83.3%	0.043^†

Values are presented as mean ± SD unless otherwise indicated.

^* t-test.

^† χ² test.

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