Two Novel Topical Transamin Application Techniques In Achieving Ocular Surface Haemostasis

To report 2 distinct techniques in achieving haemostasis in primary pterygium excision with autologous conjunctival graft intraoperatively.

Prompt haemostasis is essential when conducting ocular surface surgeries. Preoperative Subcutaneous and subconjunctival injection has been reported in the literature with contradicting results. The direct application of topical transmin in pterygium surgeries have yet to be discussed. 

Intraoperative topical transamin in achieving haemostasis in pterygium surgeries are illustrated. The first method being cotton bud being nudged between the conjunctiva and the sclera for a direct pressure effect, then being soaked with transamin with a cannula during pterygium surgery. The second method utilises multiple sponge spears, with handles cut prior, being inserted into the subconjunctival space, followed by transmin injection to achieve haemostasis during pterygium surgery.

With the combined physical (direct pressure) and chemical (transamin) effect, haemostasis has been achieved efficiently. The advantages of the first method are 1) efficient against focal bleeding, 2) frees the hands of the surgeon while awaiting haemostasis, and 3) the retained cutton bud handle prevents loss in the subconjunctival space. The second method is efficient against relatively extensive bleeding with a more extensive contact site, but care has to be taken to prevent any loss of sponges during retrieval.

The two topical transamin application methods are effective against ocular surface bleeding. Postoperative follow-up do not yield any systemic or local complication from the use of topical transamin.