Parameters of Successful Ptery-gium Surgery with Fibrin Glue

Chan Young Im, MD 1

Bong Jun Choi, MD 2

1 Ian Eye Center, Seoul, Korea2 Lee Eye Clinic, Busan, Korea

We have no financial interest for this presentation.

Pterygium surgery• Koranyi G et al.

Cut and paste: a no suture, small incision approach to pterygium surgery.

Br J Ophthalmol. 2004• Harvey S. et al.

Comparison of Fibrin Glue and Sutures for Attaching Conjunctival Autografts after Pterygium Excision

Ophthalmology 2008• Marcelo Ayala

Results of Pterygium Surgery Using a Biologic Adhesive Cornea Volume 2008

Methods• 417 primary pterygium• Autologous conjunctival transplantation• Tissucol Duoquick ( Baxter, Vienna, Austria

)• Follow up 6 months• Parameters– Recurrence : 1mm over limbus– Operation time : speculum time– Flap size : 4,5,6,7,8 mm in diameter– Complications

Inclusion criteria• Primary pterygium• Size 0.5 mm from limbus• Bilateral pterygium

– One eye randomly chosen• Exclude

– recurred, pseudopterygium

Patient characteristics• Age

42.73 11.59 ( 22 ~ 77 )

• SexM : F = 198 : 219

• Pterygium size

Small Moderate Large

size < 1.5mm from limbus

1.5 ~ 2.5 mm from

limbus

> 2.5 mm from limbus

n 206 170 41

Surgical technique• Anesthesia

– Subconjunctival xylocaine• Pterygium removal

– Wescott scissors• Conjunctival donor graft

– Superior limbus side• Fibrin glue

– Fibrinogen on scleral bed– Thrombin on graft

• Medication– Rimexolone q.i.d for 1 month postop– Levofloxacin q.id. For 1 week postop

Photo Preop Postop

Recurrence• 3 ( n=417 ) : 0.7 %• Female n=2 , Male n=1• Discussion– Small flap size < 6 mm – F/31, F/37, M/40

Operation time• 11.8 2 minutes

Complications• Recurrence : 0.7%, 3 ( n= 417 )

• Short term complications– Subconjunctival hemorrhage : 15, 3.5%– Flap swelling : 49, 11.7%– Flap dehiscence : 31, 7.4%

Complications* Subconjunctival hemorrhage ( POD 1wk )* Flap swelling ( POD 1wk ) : 49,

11.7%

ComplicationsFlap dehiscence : 31, 7.4%

ComplicationsRecurrence ( n=3 / 417 )

Conclusion• Fibrin glued pterygium surgery is effective method

with low recurrence, short operation time and few complications.

• Parameters related to recurrence after fibrin glued autologous conjunctival graft are small flap size ( smaller than 6 mm ), younger age ( under age 40 ).