Earlier Corneal Topographical Changes After Different Pterygium Surgical Techniques: a Comparative Pentacam Scheimpflug Imaging Study

Purpose: To investigate earlier corneal topographical changes and visual acuity after different pterygium surgical techniques using the Pentacam Scheimpflug imaging system.Methods: This study enrolled 98 patients with unilateral primary nasal pterygium. Pterygium surgery with either a conjunctival autograft (group 1) or an anchored conjunctival rotational flap (group 2), with fibrin tissue adhesive was performed under topical anesthesia. Baseline and one-month post-operative best-corrected visual acuity (BCVA) in logarithm of the Minimum Angle of Resolution (logMAR) and anterior corneal astigmatism (ACA), flat keratometry (Kf), steep keratometry (Ks) and posterior corneal astigmatism (PCA) were analyzed.Results: Mean BCVA improved from baseline 0.119±0.113 to 0.082±0.086 logMAR in group 1, and from baseline 0.169±0.128 to 0.120±0.121 logMAR in group 2. There were no statistically significant differences between the two groups in pre-and post-operative ACA, PCA, Kf and Ks. (p=0.686; 0.9020.107; and 0.592, respectively). Intra-group analysis revealed statistically significant differences in both groups: ACA (p<0.001 for both groups), with a greater difference in group 1 (2.072), and Kf (p<0.001 for both groups), with a slightly greater change in group 2 (1.910). While there were no statistically significant Ks intra-group differences in both groups (group 1: p=0.091; group 2: 0.092), group 1 (0.0522) displayed more Ks changes. There were also no statistically significant intra-group PCA differences in both groups (p=0.061 for both groups). However, Group 2 (-0.020) displayed greater changes.Conclusions: Significantly improved anterior corneal topographical changes highly associated with conjunctival autografting. However, the conjunctival rotational flap was associated with relatively greater posterior corneal topographical changes.

Adesivo tecidual de fibrina versus suturas para o enxerto autólogo de conjuntiva em cirurgias primária de pterígio: uma revisão integrativa / Fibrin tissue adhesive versus sutures for autologous conjunctiva graft in primary pterygium surgery: an integrative review

Introdução: Pterígio caracteriza-se pelo crescimento benigno fibrovascular, que surge da conjuntiva e se estende para a córnea. Atualmente a excisão cirúrgica, com enxerto autólogo de conjuntiva, constitui-se o tratamento padrão-ouro. No entanto, a sutura do enxerto é uma etapa demorada podendo induzir ao processo inflamatório local. Objetivo: Comparar os estudos sobre tratamento cirúrgico de pterígio confrontando a efetividade do adesivo tecidual de fibrina com as suturas no enxerto autólogo de conjuntiva. Método: Tratou-se de revisão integrativa utilizando-se da estrutura PICO para elaboração da pergunta norteadora. Os estudos foram levantados nas bases de dados: Cochrane Library, Medline via portal PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Eletronic Library Online) e Science direct. A ferramenta utilizada para indexação e recuperação de assuntos na literatura foi Descritor de Ciências da Saúde. Os critérios de inclusão foram: ensaios clínicos, randomizados, publicados entre 2015 a 2020 e disponíveis na íntegra. Resultados: Identificou-se duzentos e oitenta e um estudos, no entanto após a aplicação dos critérios de inclusão e exclusão restaram apenas cinco artigos. O tempo cirúrgico variou entre os tipos, sendo de 3,6 minutos a 20,17 ± 3,23 minutos para adesivo de fibrina e de 13,3 minutos a 32,42 ± 4,47 minutos para as suturas. Dentre os desconfortos oculares estavam sensação dolorosa e de corpo estranho, hiperemia conjuntival, hemorragia, edema e secreção. A recorrência foi observada em 19,9% dos voluntários dos estudos sendo 19,8% após o uso do adesivo de fibrina. Conclusão: Adesivo de fibrina mostrou-se seguro e eficaz para fixar enxerto autólogo de conjuntiva nas cirurgias de remoção de pterígio, mostrando-se capaz de reduzir o tempo operatório e as principais queixas dos pacientes no pós operatório imediato. No entanto, não oferece redução na taxa de recorrência, por isso deve-se atentar para risco aumentado de hemorragia conjuntival.Palavras chave: Pterígio, Adesivo tecidual de fibrina, Suturas ABSTRACT Introduction: Pterygium characterized by benign fibrovascular growth that arises from the conjunctiva and extends to a cornea. Currently, surgical excision with autologous conjunctival autograft is the gold standard treatment. However, suturing the graft takes a long time and induces a local inflammatory process. Objective: To compare studies on the surgical treatment of pterygium confronting the effectiveness of fibrin tissue adhesive with sutures in conjunctival autograft. Methodology: It was an integrative review using the PICO structure to elaborate the guiding question. The studies were surveyed in the databases: Cochrane Library, Medline via PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Electronic Library Online) and Science direct. The tool used for indexing and retrieving subjects in the literature was a Health Sciences Descriptor. The inclusion criteria were: clinical trials, randomized, published between 2015 and 2020 and available in full. Results: Two hundred and eighty-one studies were identified, however, after applying the inclusion and exclusion criteria, only five articles remained. The surgical time varied between types, ranging from 3.6 minutes to 20.17 ± 3.23 minutes for fibrin adhesive and 13.3 minutes to 32.42 ± 4.47 minutes for sutures. Among the eye discomforts were a painful sensation and a foreign body, conjunctival hyperemia, hemorrhage, edema and secretion. Recurrence was observed in 19.9% of the study volunteers, with 19.8% after the use of fibrin adhesive.Conclusion: The use of fibrin glue is safe and effective for fixing the autograft in pterygium removal surgeries, proving capable of reducing the operative time and the main complaints of patients in the immediate postoperative period. However, it does not offer a reduction in the recurrence rate and attention should be paid to the increased risk of conjunctival hemorrhage.Keywords: Pterygium, Fibrin tissue adhesive, Sutures

“Double-Stick Tape” Technique for Transposition of an Offending Vessel in Microvascular Decompression: Technical Case Report

Background And Importance: Severe hemifacial spasm caused by compression by a tortuous vertebral artery (VA) often is encountered and is difficult to treat. We describe a patient with hemifacial spasm caused by compression of the facial nerve by a tortuous VA. A simple and effective transposition approach, a “double-stick tape” technique, to the offending artery using a fibrin tissue-adhesive collagen fleece product (TachoComb) is reported. Clinical Presentation: A 65-year-old woman presented with an 8-year history of right-sided facial spasms, including the orbicularis oculi and orbicularis oris muscles. MRI revealed a tortuous right VA indented into the pontomedullary junction. The right anterior inferior cerebellar artery (AICA) also contacted the proximal portion of the facial nerve. Surgical exploration with standard retrosigmoid craniotomy was performed. The offending VA was dissected away from the pontomedullary junction toward the cranial base. A small piece of TachoComb, with fibrin glue applied on the non-coated side of the fleece to make a “double-stick tape,” was then placed on the ventral surface of the VA. Until the glue hardened, the VA was held away from the brainstem onto the dura of the petrous pyramid. After this procedure, AICA transposition was performed. The patient’s symptoms were completely resolved immediately after surgery, and she remained asymptomatic at her 1 year follow-up visit. Conclusion: The advantage of our “double-stick tape” technique is the simplicity of the procedure. The present technique is a feasible alternative for the treatment of hemifacial spasm caused by a tortuous VA.