Botropase optimized conjunctival tissue grafting (BOT-Graft): Bridging efficacy, safety, and affordability in primary Pterygium surgery

Pterygium excision with conjunctival autografting is the preferred surgical approach for preventing recurrence. However, the ideal method for graft fixation remains debatable. This study describes a novel technique using hemocoagulase (Botropase) for conjunctival autograft fixation in pterygium surgery. Botropase, derived from snake venom, facilitates fibrin matrix formation at the graft-host interface without the drawbacks of traditional methods. Our initial series demonstrated a mean surgical time of 18.3 min, significantly shorter than sutured techniques (32.42 min) and comparable to fibrin glue (20.17 min). The procedure showed excellent graft stability with minimal complications and no recurrences during the follow-up period. At approximately 3 USD per vial, Botropase offers a 95 % cost reduction compared to fibrin glue, making it particularly valuable for high-volume centers and developing economies. This technique represents a promising advancement in pterygium surgery by combining the precision of fibrin glue with the affordability of autologous blood while mitigating their respective limitations.