Sutureless And Glue-Free Conjunctival Limbal Autograft In Primary Pterygium: A Cost-Effective Surgery Technique In Medical Missions Trips

Our study aims to evaluate the effectiveness of a sutureless and glue-free conjunctival limbal autograft technique in managing primary pterygium, a fibrovascular growth linked to UV exposure. Symptoms range from redness and irritation to blurred vision as the pterygium extends toward the cornea, encroaching on the visual axis. Conventional surgical methods involving sutures or biological glue can be time-consuming and costly. Our study sought to demonstrate how the sutureless approach alleviates symptoms and enhances visual acuity while cutting down on time and expenses. This advancement holds particular significance during medical missions, where numerous patients from socioeconomically disadvantaged areas seek this essential surgery.

During a four-month mission trip, the study was conducted in Ighrem, Morocco, nestled within the Grand Atlas Mountains of North Africa.

Set in a mountainous region, this prospective interventional study aimed to address primary nasal pterygium. 100 eyes underwent surgical intervention, administered by a single surgeon. Patients were stratified into two groups: the first, comprising 35 individuals with an average age of 65 years and a predominance of 73% women, underwent the bare sclera technique. The second group, consisting of 75 individuals with an average age of 37 years and a balanced gender distribution, underwent pterygium excision and conjunctival limbal autograft using patient blood for graft fixation. All enrolled pterygium cases exhibited encroachment onto the visual axis by at least 3 mm. Follow-up assessments were conducted for three months postoperatively.

The primary indication for pterygium surgery was grade III or IV pterygium encroaching on the visual axis. Due to the patient's age, a bare sclera approach was chosen in the first group. Visual acuity improved by two lines post-excision, with only one patient showing early recurrence at three months follow-up. In the second group, a sutureless conjunctival limbal autograft was performed to mitigate pterygium recurrence, while considering the cost constraints of a mission trip. Among this younger cohort, visual acuity increased by four lines post-surgery. Complications included 2 graft losses, 3 graft oedema, and 5 graft retractions but none necessitated further surgical intervention. No recurrences were observed after three-month follow-up.

Our study underscores the effectiveness and cost-efficiency of the sutureless glue-free conjunctival limbal autograft technique in pterygium surgery. It demonstrates comparable recurrence rates to traditional methods involving sutures or glue fixation of the graft, while notably reducing surgical time. This is particularly crucial for medical mission trips, enabling more surgeries within limited resources. Although longer follow-up periods would provide more comprehensive insights, the observed outcomes at three months are promising. Furthermore, patients undergoing the sutureless technique experience less postoperative discomfort without compromising on visual outcomes, underscoring its clinical advantages.