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

Abstract

Aim: Evaluation of the benefits of a new technique for pterygium surgery with respect to postoperative pain and surgery time.

Methods: A prospective randomised clinical trial was carried out in 43 patients. 43 eyes were operated for primary nasal pterygium. Autologous conjunctival graft taken at the superotemporal limbus was used to cover the sclera after pterygium excision. After randomisation, in 20 patients the transplant was attached to the sclera with a fibrin tissue adhesive (Tisseel Duo Quick) and in 23 patients with absorbable sutures (7-0 Vicryl Rapid). The Mann-Whitney test was used as statistical analysis. Postoperative pain was graded according to the visual analogue scale (VAS) twice daily during the first week after surgery. Surgery time was noted from the first incision until the lid speculum was removed.

Results: The average pain was significantly lower when glue had been used, p<0.05. Average surgery time was 9.7 minutes (range 6-13) for glue and 18.5 minutes (range 12-30) for sutures, p<0.001. No complications occurred.

Conclusion: Using glue instead of sutures when attaching the conjunctival transplant in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

Figures

Figure 1

Blunt dissection of the pterygium head. Autotransplant is marked at the superotemporal limbus.

Figure 2

Pterygium is excised. The conjunctival transplant is prepared lying upside down on the cornea.

Figure 3

The conjunctival graft is slid nasally with the limbal edge facing towards the limbus. One drop of the thrombin solution (A) and one drop of the protein solution (B) are placed.

Figure 4

The graft is flipped over and glued.

Figure 5

Medians of postoperative VAS values in the glue and the suture group monitored twice daily.

Figure 6

Medians of the adjusted postoperative VAS values. Glue and suture group monitored twice daily. At each point of time p

Figure 7

Box plot of surgery times in minutes. Medians, quartiles, minimum, and maximum values for each group are shown. The difference is significant, p