University of Florence

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• University of Florence
• Oto-Neuro-Ophthalmological Department
• Eye Institute

Alessandro Franchini MD Eleonora Vaccari MD
Iacopo Franchini
Conjunctival autograft and fibrin glue in
pterigium surgery
The authors have no financtial interest in the
products and the materials mentioned in the poster
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Pterigyum is a fibrovascular triangular membrane
that forms over the perilimbal conjunctiva and
extends into the cornea
When pterygium nears the optical zone or causes
chronic inflammation, surgical removal is the
treatment of choice. Over the past few years
several surgical techniques for the treatment of
pterigyum have been introduced. Among them
excision with or without conjunctival or scleral
sutures is the easiest to perform but presents a
high incidence of postoperative discomfort and
recurrence. To avoid these complications the use
of mitomycin C or irradiation was introduced with
good results but with a high risk of severe
corneal and scleral complications. The
introduction of the conjunctival autograft
transplant represented a significant innovation
in decreasing complications and recurrence.
However, the need for many sutures required an
increase in surgical time and the sensation of a
foreign body presence in the eye following
surgery.
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Material and Methods
The authors have treated 18 patients, 12 affected
by primary nasal pterigyum and 6 by recurrent
pterigyum. The surgical technique consists of
fixing the graft using a fibrin adhesive after
removal of the pterigyum.
Fibrin glue (Tissucol Duo Baxter AG
,Vienna,Austria) imitates the final stage of the
coagulation process. It is composed of two
different components. The first syringe contains
factor VIII, plasminogen, plasma fironectin and
fibrinogen. The second contains a human thrombin
solution. The two separate syringes are placed in
an injection system which allows us to mix the
components in the correct proportion. All the
patients were controlled at 1 day, 2 days, 3
days, 1 week, 1 month and 1year follow-up
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Surgical technique 1
All the patients were operated on under sub
tenonian anesthesia
After the dissecation of the pterygium with the
standard technique, a free conjunctival graft of
3mm for 6 mm is obtained from the superotemporal
area of the same eye
The graft is then spread over the cornea near the
previously cauterized bare sclera
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Surgical technique 2
Depending upon the circumstances, few or more
drops of the fibrinogen solution are applied to
the bare sclera and few or more drops of the
trombin solution to the stromal surface of the
conjunctival graft. The conjunctival graft is
then placed on the sclera with close attention
paid to maintaining the versus and the
orientation
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3 days after surgery 3 days after surgery

3 weeks after surgery 3 weeks after surgery

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Results
The mean surgical time was 15 33 3 54. No
complications occurred during surgery or in the
immediate postoperative period. During the first
postoperative week none of the patients felt
pain, and only 3 patients (25) had postoperative
discomfort syndrome with a mild sensation of the
presence of a foreign body. In all the patients
the flap was correctly positioned at 1-month
follow-up and there was no relapse after the
1-year follow-up. No cases of re-growth of
pterygium during the follow-up period were found.
Conclusion
In conclusion, conjunctival autograft
transplantion is a very safe procedure which
provides a decrease in the risks of complications
and recurrence rate. In comparison to the
amniotic membrane transplant which presents the
same results, it requires less time and is less
expensive. Furthermore, the use of an adhesive
glue instead of sutures reduces surgical time,
patient postoperative discomfort and foreign body
sensation.
REFERENCES Bahar I,Weinberger D,Dan G,Avisar R.
Pterygium surgery fibrin glue versus vicryl
sutures for conjunctival closure. Cornea 2006
vol.25,101168-1172 Kucukerdonmez C,Akova
YA,Altinors DD.Comparison of conjunctival
autograft with amniotic membrane transplantation
pterygium surgery and cosmetic outcome. Corna
2007 may26(4)407-413. Marticorena
J,Rodriguez-Ares MT et al.Pterigyum surgery
conjunctival autograft using a fibrin adesive.
Cornea 2006 Jan 25(1)34-36 Uv HS,Reves
JM,Flores JD ,Lim-Bon-Siong R. Comparison of
fibrin glue and sutures for attaching
conjunctival autografts after pterygium excision.
Ophthalmology 2005 apr112(4)667-671