A Multivariate Analytical Study on Surgical Outcomes of Pterygium Excision and Conjunctival Autograft Fixation by Autologous Serum vs. Sutures in a Tertiary Eye Care Centre

Author(s): Devika Krishnadas1 , Smitha Mohan2 , Raja Ayyakutti Muni3 , Nayana Ramankutty4

BACKGROUND Best surgical approach to prevent recurrence of pterygium is conjunctival autografting after pterygium excision. Most commonly, conjunctival autograft is secured with sutures, but newer technique is graft fixation with autologous serum which is used as tissue adhesive for securing the conjunctival auto graft, in which there is no need of glue or sutures for fixing the auto graft. The present study was done to compare the efficacy, patient’s comfort and outcomes between the two methods of securing conjunctival limbal autograft fixed with autologous serum with those of sutures in the management of primary pterygium. METHODS A multivariate analytical study was conducted among 60 eyes with primary progressive nasal pterygium and those who were willing for surgery. Patients were randomly divided into two groups. Pterygium excision was done, and conjunctival auto graft was fixed in group A with autologous serum and in Group B with absorbable 8-0 Vicryl sutures. The operating time taken for the procedure was recorded. To compare the efficacy of the two procedures graft recipient site attachment was noted. Post-operative outcomes such as post-operative discomfort, graft oedema, graft displacement, graft retraction, granuloma formation, and recurrence of pterygium were observed. RESULTS The mean age of the patients included in this study was 57.27 years. 40% were males and 60% were females. 82% people were involved in outdoor work. The mean time taken for surgery in autologous serum group was 28.17 minutes and in suture group was 35.5 minutes, Student’s t test showed significant difference between the two with a P value of 0.000. Post-operative discomfort and pain was more in group B than in group A. Among postoperative complications, graft oedema was seen in 6 eyes in group A and 4 eyes in group B and all cases of graft oedema resolved within 4 weeks. In group A, minimal displacement of graft edge of 0.5 mm - 1 mm on to the corneal side was noted in 2 patients and severe displacement was seen in one patient. CONCLUSIONS Our study suggests that autologous blood is a useful alternative method for graft fixation in pterygium surgery instead of sutures. Efficacies of both the techniques are comparable. Postoperative discomfort and surgical time required are significantly less in autologous serum method. Incidence of graft displacement and graft loss is more with autologous serum technique, but it was not statistically significant in our study.