hubhankar Poddar
BACKGROUND Pterygium is excessive sub-conjunctival proliferation of fibrovascular tissue or elastotic degeneration of tissue under the epithelium. Pterygium is seen nearly twice as often in men as in women. Ophthalmologists had a real challenge for successful management pterygium due to its high recurrence rate (2.1% to 87%). Pterygium is a local limbal cell deficiency. Pterygium recurrence can be reduced if the limbus and limited area of cornea are included in the conjunctival graft, as it is well recognized that limbal stem cells play a vital role in maintaining the ocular surface. The objective of the study is to evaluate effectiveness and outcome of two surgical procedures for conjunctival autograft fixation- with autologous blood vs. polyglactin suture. To evaluate the outcome of the two surgical technique in terms of surgical time, post-operative pain and discomfort, graft related complication, uptake of graft, recurrence. MATERIALS AND METHODS This was a prospective, comparative interventional, case series of 60 eyes over a period of three years. These 60 patients were divided into two group. In this study, in 30 eyes of the patients, pterygium excision with conjunctival autograft was secured with 8-0 polyglactin sutures and were allocated to group A. The remaining 30 eyes of the patients who underwent pterygium excision with conjunctival autograft were secured with auto blood and they were allocated to group-B. RESULTS In this study, mean age of the patient in group-A is 44.7 ± 8.2 and in group-B 47.8 ± 8.8. Sex distribution in Gr-A- 50% were male and 50% were female. In Gr-A 67.7% were male and 37.7% female. Side of involvement- in gr-A right side involvement 76.7% and left side was 23.3%. Length of pterygium encroaching over cornea in mm (mean) S.D. 3.0 ± 0.40 in Gr-A (mean) S.D. 2.95 ± 0.59 in Gr-B. Vessel pattern in Gr-A. Thin vessel 33.3%, Tortuous vessels 30%, Vascular band 36.7%. In Gr-B thin vessel 43.7% Tortuous vessels 30.5%, Vascular band 26.3%. Operation time in Gr-A 37.3 ± 8.2 min and in Gr-B 17.5 ± 2.3 min. Average time difference was 19.8 min. Regarding graft fixation time- in Group A graft fixation time was fixed for 24 hours. In Group B graft fixation time was gradually decreased from 48 hours to 20 hours. In Graft related complication 20% in Gr-A 13.3% in Gr-B. In terms of recurrence 16.7% in Gr-A and 6.7% in Gr-B and p value P<0.67 which was clinically significant. Relation in between recurrence & vessel pattern (vascular band). The risk of recurrence significantly increases when there in presence of vascular bands. The estimated risk is 1.5 with a 95% CI. CONCLUSION Conjunctival auto blood auto graft is superior to suturing procedure. It is a less invasive surgery than in suturing group. It has less post-operative inflammation. It has less graft related complications at the end of 6 months. It has less chance of recurrence on following up for a period of 6 months. It has early rehabilitation time. It is cost effective. It has good cosmetic effect because it has smooth operative surface area and has good cosmetic and functional outcome.
