Effectiveness Of Limbo-Conjonctival Autograft Transplantation And The Use Of Fresh Scleral Autologous Blood In Primary Pterygium Surgery: A Retrospective Study Of 98 Cases

Pterygium is a fibrovascular overgrowth of bulbar cunjunctiva over the cornea and may produce visual impairment. 
Many surgical techniques and adjunctive therapies have been proposed but recurrence remains frequent.
This study focuses on the benefit of using fresh scleral autologous blood to improve the reference surgical technique for pterygium, which is limbo-conjunctival autograft comparing other techniques of placing the autograft: fibrin glue and sutures. 

Ninety eight (98) eyes of forty nine 49 patients with primary pterygium were included in a prospective study.

Excision of the pterygium head by lamellar keratectomy is followed by removal from the scleral limbus of a conjunctivo-limbal graft corresponding to the dimensions of the pterygium excision area. 

For the fixation of the limbo-conjunctival autograft,  the study population of 98 eyes was divided into three groups :

Group1 : classically buried sutures with 10/0 mono-filament for the limbal hinge and 8/0 Vicryl for the conjunctival flap,

Group 2 : biological fibrin-based glue,

Group3 : fresh autologous blood from scleral scarification of the fixation site.

A soft lens is placed for 3 days with a compressive eye dressing. Local corticosteroid therapy post-operatively was initiated while patients are reviewed at 1,3,6 and 12 months. All three groups were compared in terms of efficiency and security: surgical time, postoperative discomfort, and recurrence

For all surgical procedures, perfect take-up of the limbo-conjunctival graft without dislocation was noted from the first month with ad integrum restoration of the corneo-limbo-conjunctival excision area of the pterygium. 
The average surgical time taken was least with autologous blood group (Group III), i.e. 27.8 min, followed by 38.5 min with fibrin glue group (Group II) and maximum of 49.1 min with suture group (Group I). Post-opérative discomfort was seen maximum in th suture group (Group I) and was minimal in the fibrin glue group and autologous blood (Groups II & III).

After an average follow-up of 12 months, one case of recurrence was seen in both Group I and Group II. No recurrence was seen in Group III.

In the light of our study, the limbo-conjunctival autograft fixed by the use of fresh scleral autologous blood could become the reference technique for the surgical management of pterygium in younger patients,  due to its simplicity, rapidity, reliability, efficiency and especially the lowest cost of this technique.