Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

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Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46334.15327 ◽

2021 ◽

Author(s):

Mona Sune ◽

Pradeep Sune

Keyword(s):

Clinical Trial ◽

Fibrin Glue ◽

Autologous Blood ◽

Randomised Clinical Trial ◽

Mild Degree ◽

Group A ◽

Pterygium Surgery ◽

Pterygium Excision ◽

Group B

Introduction: Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. Aim: To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. Materials and Methods: It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow- up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. Results: The mean age of patients in group A was 48.32±14.3 years (21-65 years), and in group B was 54.48±15.67 (23-74 years). Mean operating time in group A was 23.21±9.4 minutes and 13.7±4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. Conclusion: This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue.

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Comparing Adjuvant Beta Radiation, Mitomycin C, and Conjunctival Autograft in Primary Pterygium Treatment, a Three-year Follow-up Study

The Open Ophthalmology Journal ◽

10.2174/1874364102014010082 ◽

2021 ◽

Vol 14 (1) ◽

pp. 82-87

Author(s):

Khalil M. Al-Salem ◽

Ahmad T.S. Saif ◽

Passant S. Saif

Keyword(s):

Postoperative Complications ◽

Mitomycin C ◽

Recurrence Rate ◽

University Hospital ◽

Beta Radiation ◽

Conjunctival Autograft ◽

Group A ◽

Pterygium Excision ◽

Group B ◽

Primary Pterygium

Purpose: To compare the recurrence rate of primary pterygium surgery after the adjuvant use of Beta radiation, Mitomycin C, and conjunctival autograft. Methods: 180 eyes of 180 patients were included in the study. All cases had primary pterygium excision following the use of adjuvant therapy of Beta radiation or Mitomycin C (0.02% for 5 minutes) or conjunctival autograft. The study was conducted at Fayoum University Hospital, Fayoum, Egypt, and Misr University Hospital. The patients were randomly divided into three groups, with each group comprising 60 patients. Group (A) included patients treated with Beta radiation following Pterygium excision, group (B) patients had primary pterygium excision with the application of 0.02% Mitomycin C for 5 minutes, and group (C) patients had conjunctival autograft to cover the bare area after pterygium excision. Patients were followed up for three years postoperatively. Results: group A had the highest recurrence rate (33.3%) followed by group B (13.3%), and finally group C presented a recurrence rate of 6.7%. Group B showed the highest rate of intra-ocular postoperative complications, while no intra-ocular complications were recorded in group C. Common complications in groups A and B were scleral melting, keratitis, and Dellen formation. Conclusion: Using conjunctival autograft after primary pterygium excision gives the best results regarding the rate of recurrence and postoperative complications. Meanwhile, B-radiation or Mitomycin C did not prove to be as good.

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Fibrin Glue Versus Autologous Serum for Conjunctival Autograft Fixation in Pterygium Surgery

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i1.1007 ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Abdul Rafe ◽

Saquib Naeem ◽

Tariq Munawar

Keyword(s):

Fibrin Glue ◽

Sampling Technique ◽

Autologous Serum ◽

Bulbar Conjunctiva ◽

Dry Eyes ◽

Conjunctival Autograft ◽

Quasi Experimental ◽

Group A ◽

Pterygium Excision ◽

Group B

Purpose: To compare the outcomes of conjunctival autograft fixation using autologous serum vs fibrin glue to cover the bare sclera in pterygium excision surgery. Study Design: Quasi experimental study. Place and Duration of Study: The study was conducted in Ophthalmology Department of CMH Kharian from April 2018 to November 2018. Material and Methods: Forty patients with primary pterygium were selected by convenient sampling technique. Patients with recurrent Pterygia and moderate to severe dry eyes, keratitis or secondary to trauma were excluded. The patients were divided into two groups, group A treated with fibrin glue and group B treated with autologous serum technique. All patients underwent pterygium excision under topical anaesthesia. The conjunctival autograft was removed from superior temporal bulbar conjunctiva to cover the scleral bed produced by pterygium excision. Post operatively the patients were followed-up for three months to assess the fixation or otherwise. Data was noted and analysed by using SPSS version 23. Results: The graft was taken-up nicely in most of the cases. The patients were followed up for three months after surgery. The frequency of graft lost in Group A and Group B was noted as n = 8 (40%) and n = 1 (5%), respectively (p = 0.008). The only other complication was recurrence of pterygium which was n = 5 (25%) and n = 3 (15%), in Group A and Group B, respectively (p = 0.429). No case of infection was noted. Conclusion: Fixation of conjunctival autograft with autologous serum is a safe and effective method and potential alternative of fibrin glue technique.

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Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

Journal of Clinical Medicine ◽

10.3390/jcm10235711 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5711

Author(s):

Miriam Idoipe ◽

Borja de la Sen-Corcuera ◽

Ronald M. Sánchez-Ávila ◽

Carmen Sánchez-Pérez ◽

María Satué ◽

...

Keyword(s):

Growth Factors ◽

Amniotic Membrane ◽

Ocular Surface ◽

Amniotic Membrane Transplantation ◽

Graft Size ◽

Conjunctival Autograft ◽

Group A ◽

Pterygium Surgery ◽

Group B ◽

Primary Pterygium

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.

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PTERYGIUM;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.01.2615 ◽

2019 ◽

Vol 26 (01) ◽

Author(s):

Arif Hussain ◽

Qundeel Shaukat ◽

Nasir Mahmood

Keyword(s):

Interventional Study ◽

Surgical Time ◽

Patient Discomfort ◽

Conjunctival Autograft ◽

Department Of Ophthalmology ◽

Group A ◽

Peribulbar Anesthesia ◽

Pterygium Surgery ◽

Group B ◽

Study Setting

Objectives: To compare graft stability, patient discomfort and surgical time between autologus blood and sutures for autologus conjunctival graft adherence in pterygium surgery. Study Design: Prospective interventional study. Setting: Department of Ophthalmology, Pak Red Crescent Medical and Dental College, Dina Nath. Period: January 2017 to December 2017. Materials and Methods: Fifty eyes of fifty patients requiring pterygium surgery were enrolled. The patients were divided in two groups (A and B). Under peribulbar anesthesia pterygium was excised in all patients. Bare sclera was covered with conjuctival autograft using autologus blood as adhesive agentin Group A while in Group B conjuctival autograft was fixed with 10/0 Nylon sutures. The patients were examined postoperatively on day 1, day 7, day 14 and day 30. The groups were compared in terms of surgical time, graft displacement and patient discomfort. Results: Mean surgical time was (20.96 ±2.05 minutes) in Group A and (30.04±3.38 minutes) in Group B. There was nasal displacement of conjunctival autograft in 3 (12%) of patients on 1stpost-operative day in Group A whereas no graft displacement was seen in any case of Group B. Level of patient discomfort measured on visual analogue scale in Group A was (0.56 ± 0.92 on day 1, 0.40 ± 0.71 on day 7, 0.04 ± 0.20 on day 14 and 0 ± 0 on day 30). In Group B level of patient discomfort was (3.92 ± 1.12 on day1, 1.24 ± 1.09 on day 7, 0.12 ± 0.33 on day 14 and0 ±0 on day 30). Conclusions: The use of autologus blood to affix the conjuctival autograft in pterygium surgery is a reliable method. It is associated with less patient discomfort post operatively and requires shorter surgical time, as compared to conjunctival autograft with sutures.

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Complications and Recurrence after Pterygium Excision using Mitomycin C Eye Drops versus Sutureless and Glue Free Conjunctival Autograft: A Prospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44271.13926 ◽

2020 ◽

Author(s):

Prachi Shukla ◽

Suman Bhartiya

Keyword(s):

Mitomycin C ◽

Recurrence Rate ◽

Eye Drops ◽

Conjunctival Autograft ◽

Group A ◽

Pterygium Excision ◽

The Difference ◽

One Year ◽

Group B

Introduction: Recurrence is the most common problem with pterygium excision. Various adjunctive methods have been described to decrease the recurrence rate of pterygium. Mitomycin C (MMC) and limbal Conjunctival Autograft (CAG) are most commonly used methods to reduce its recurrence. Aim: To compare the recurrence rate of pterygium and the complications with MMC eyedrops after bare sclera pterygium excision versus sutureless and glue free CAG. Materials and Methods: Total 104 eyes were divided into two groups (A and B) of 52 eyes each. Group A patients underwent bare sclera excision of pterygium followed by 0.01% MMC eye drops BD (twice a day) for five days and Group B patients had sutureless and glue free CAG using oozing blood as tissue adhesive after pterygium excision. The patients were followed-up postoperatively on day 1, day 3, day 7, one month, three months, six months and one year. All the patients were examined for recurrence and complications. Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version 16 and student’s t-test was applied for comparison. Results: A total of 104 eyes of 92 patients were divided into two groups (A and B) of 52 each. The mean age of Group A was around 45 year and group B was around 43 years and the difference was statistically insignificant (p>0.05). Total three patients had recurrence in one year of follow-up in group A, out of which first case appeared before the end of 1st month, second before the completion of 3rd month and the third case at the last follow-up. In group B only one case presented with recurrence at 6th month follow-up. The difference between the recurrences in both the groups was statistically insignificant (p>0.05). Short term complications were observed in five patients in group A. One patient had corneal thinning; one had scleral thinning, two patients presented with avascular sclera and one patient with granuloma. In group B, 18 patients with graft retraction, eight with graft oedema, five with sub-conjunctival graft haemorrhage and one with granuloma were observed. All these complications resolved by the time. Long term complications were not observed in any patient of both the groups. Conclusion: This study concluded that the use of MMC eye drops (0.01%) BD or glue free and sutureless CAG after pterygium excision is safe and effective treatment modalities for pterygium.

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A comparative study of conjunctival autograft with fibrin glue or glueless sutureless conjunctival autograft after pterygium surgery

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180297 ◽

2018 ◽

Vol 6 (2) ◽

pp. 557

Author(s):

Kalpna Jain ◽

J. M. Manoher

Keyword(s):

Fibrin Glue ◽

Cost Effective ◽

P Value ◽

Conjunctival Autograft ◽

Group A ◽

Pterygium Surgery ◽

Randomized Control ◽

Group B ◽

Control Study ◽

Conjunctival Autografting

Background: Conjunctival autografting after Pterygium excision can be done by fibrin glue or sutures but use of foreign material can cause discomfort and infection. Fibrin glue may cause hypersensitivity reaction and also have risk of viral transmission. To avoid these conjuctival autograft can be applied without suture or glue. Patient’s own blood act as a bioadhesive.Methods: We done a prospective randomized control study of 70 patients, 35 patients allocated in each group. Group A had conjunctival autograft with fibrin glue while group B had conjunctival autografting without glue or sutures.Results: In group A 31 and group B 26 patients had well placed conjunctival autograft while 4 in group A and 9 patients in group B had either displaced or dislodged graft. The results were statistically insignificant with P value of 0.219 and No complication was reported in any patient except recurrence. The 5 patients in group A and 6 in group B had recurrence which is not statistically significant.Conclusions: Graft stability is more with fibrin glue as compare to glueless and sutureless conjunctival autografting but using patients own blood as bioadhesive is safer and cost effective. The rate of recurrence is similar in both the groups.

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Aesthetic outcome and patient’s quality of life in breast cancer patients undergoing mastectomy with or without immediate reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12587 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12587-e12587

Author(s):

Sidra Afzal ◽

Asad Parvaiz ◽

Nida Javed

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Well Being ◽

Mean Difference ◽

Breast Cancer Patients ◽

Immediate Reconstruction ◽

Patient’S Satisfaction ◽

Group A ◽

The Mean ◽

Group B

e12587 Background: : Although post mastectomy Immediate breast reconstruction has shown to improve physical and psychosocial well-being of breast cancer patients, this is not a usual procedure in Pakistan due to limited resources and lack of awareness. The aim of our study is to evaluate patient’s satisfaction/ aesthetic outcomes between the patients undergoing mastectomy alone (Group A) and the ones undergoing mastectomy followed by immediate reconstruction (Group B). Methods: This is a prospective study conducted at Shaukat Khanum Hospital Pakistan comparing aesthetic outcome, patient’s satisfaction and Quality of life between two groups using Breast Q module. All patients undergoing mastectomy with and without reconstruction between April 2017 to July 2019 are included. Sample size of 84 was calculated (42 in each group). Results: The mean Q score of satisfaction with the breast in group B is 82.64 and in group A is 35.82 (P = 0.001). The mean Q score of Psychosocial well-being in group B is 89 vs 44.95 in group A (P = 0.001). The mean Q score of Physical well-being in group B is 98.23 vs 90.41 in group A (P = 0.002). The mean Q score of sexual well-being in group B is 81.93 vs 43 in Group A (P = 0.001). [Mean difference in score of 5-10 - little change, 10-20 - moderate change, > 20 - significant change].The mean difference between two groups in satisfaction with breast , psychosocial well-being and sexual well-being is more than 20 with a statistically significant p-value, while in physical well-being the mean difference is 7.8 which falls in little change group. Conclusions: Our study shows that reconstruction helps breast cancer patients in providing comprehensive care in a manner that they achieve a higher satisfaction with their appearance, psychological and sexual well-being without compromising oncological safety and this should be practiced more in our country. Also patients education about these procedures should be raised to help them fighting against this disease

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Prophylactic corneal cross-linking in LASIK surgery: effects on visual outcome and recovery time

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i1.451 ◽

2020 ◽

Vol 17 (1) ◽

pp. 61-68

Author(s):

Dominique Clare Oh ◽

Yiong Huak Chan ◽

Sao Bing Lee ◽

Jovina Li Shuen See

Keyword(s):

Visual Acuity ◽

Side Effects ◽

Recovery Time ◽

Visual Outcome ◽

Cross Linking ◽

Safe Procedure ◽

Distance Visual Acuity ◽

Visual Outcomes ◽

Group A ◽

Group B

Introduction: Collagen cross-linking is a useful adjunct in preventing corneal ectasia after laser-assisted in situ keratomileusis (LASIK). This study aimed to evaluate whether prophylactic cross-linking in IntraLase LASIK affects optimum visual outcome and recovery time in the immediate post-surgery period and is associated with any side effects. Methods: This was a retrospective case study on the right eyes of 100 Chinese subjects aged 18 to 40 years who underwent IntraLase LASIK. Fifty subjects who underwentcross-linking after completing LASIK (Group A) were compared with 50 subjects who did not undergo LASIK (Group B). Cases were evaluated for pre- and post-operative spherical equivalent, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), recovery time and presence of side effects. Results: At 1 week post-LASIK, mean (SD) UDVA of Group A subjects was poorer than Group B, at 1.05 (0.19) vs 1.17 (0.19) (p = 0.036); however, there was no significant difference in CDVA (p = 0.095). By 1 month post-LASIK, differences in both UDVA and CDVA were insignificant (p = 0.055, 0.106, respectively). Mean recovery time was 2.72 (95% confidence interval [CI] = 0.64-4.7) days longer in Group A (p = 0.010), although by 1 month post-LASIK, both groups were able to achieve CDVA equal to or better than that achieved pre-LASIK. Incidence of mild inflammation and dry eyes post-LASIK was similar in both groups (p = 1.00, 0.749, respectively); no other complications were observed. Conclusion: No differences in visual outcomes at and occurrence of side effects at 1 month post-LASIK were observed between subjects who underwent cross-linking prior to refractive surgery and those who did not. However, the group that underwent cross-linking had a slightly longer mean recovery time. Our study supports prophylactic cross-linking as a safe procedure that does not affect immediate visual outcomes among the Chinese population when used in adjunct with LASIK surgery.

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Evaluation of changes in choroidal thickness after implantable collamer lens surgery in high myopia patients with Graves’ Ophthalmopathy (inactive phase)

10.21203/rs.3.rs-27964/v1 ◽

2020 ◽

Author(s):

Fanglin He ◽

Yan Liu ◽

Renbing Jia ◽

Jing zhang

Keyword(s):

Visual Acuity ◽

High Myopia ◽

Choroidal Thickness ◽

Control Group ◽

Safety Index ◽

Implantable Collamer Lens ◽

Graves Ophthalmopathy ◽

Group A ◽

Efficacy Index ◽

Group B

Abstract Background To evaluate the safety and effectiveness of the Visian Implantable Collamer Lens (ICL) implantation in high myopic patients with inactive Graves’ ophthalmopathy (GO) by observing the changes of choroidal thickness (CT). Methods Eight patients (16 eyes) with high myopia accompanied with inactive GO were selected as the experimental group (group A) and 18 high myopic patients (36 eyes) without GO were selected as a control group (group B). The outcomes of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), safety index, efficacy index, intraocular pressure (IOP), vault, corneal endothelial count, and choroidal thickness (CT) were observed. The values of CT were measured using swept-source optical coherence tomography (SS-OCT) scans. Results The UCVA and BCVA in all operated eyes were better than that before surgery. The postoperative safety index and efficacy index were 1.23 and 1.19 in the group A, respectively, and 1.26 and 1.21 in the group B, respectively. In both groups, foveal CT increased significantly in high myopic patients at 2 hours and at 3 months after surgery, compared to preoperative values. The same tendencies were observed in the inner nasal and outer nasal regions. Compared with patients without GO, the increase of CT was more obvious in GO patients, 2 hours postoperatively (P = 0.006) and 3 months postoperatively (P = 0.011). Conclusions The ICL implantation is safe and effective in high myopic patients with inactive GO. Subfoveal and nasal CT may be useful parameters for monitoring the activity of GO patients.

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