Efficacy of suture less and glue-free conjunctival autograft in pterygium surgery

This study analyses the factors influencing the graft stability after a suture less and glue-free conjunctival autograft in pterygium surgery. Patients and method: A prospective study, all patients underwent pterygium surgery with suture less glue less conjunctival autografting. The parameters studied were: Intraoperative, evaluation of graft stability at the end of the procedure. Postoperative, the graft position on day 1 after surgery. Results: Sixty-four grafts remained stable at the end of the intervention, i.e. 83.12% while 16.88% were unstable. In the postoperative follow-up, 79.22% of grafts were well-positioned including 76.62% of grafts flattened in place and 2.60% of grafts retracted. Grafts displacements were observed in 20.78% of cases including 11.69% of minor displacements and 9.09% of major displacements. One patient had an excessive bleeding, which stopped on day one postoperative. Unstable grafts (84.62%) developed secondary displacements compared to stable grafts (7.81%). The difference was statistically significant, P=002. Out of the 7 cases with major displacement, 5 cases had unstable grafts (6.49%), and 2 cases had stable grafts (2.59%). Conclusion: It is an effective and safe technique with good graft position and stability despite intraoperative surgical adjustments as formerly described in the literature. The absence of postoperative irritation and suture related complications makes it a useful method for graft fixation in pterygium surgery. However, still some improvements are needed for better graft stability. Introduction Conjunctival autografting is giving good results in pterygium surgery [1,2]. The most commonly used means of fixating conjunctival autografts is by sutures or fibrin glue [3,4]. More recently, the use of autologous blood has been reported to be advantageous in minimizing the risk of postoperative infection, irritation and a reducing in the cost of surgery. However, the absence of suture or biological glue poses problem of graft fixation. Indeed, this graft fixation is potentialized by fibrin glue at the junction of the conjunctival autograft and the conjunctival bed [5]. In a review of the literature conducted in India, major displacement rates ranged between 0 to 12% while Boucher in Canada noted a 20% rate of graft loss [6,7]. Several studies have shown that on the first postoperative day the graft is already firmly fixed [6,8]. Most graft loss occurs before this time. This study presents some technical aspects aimed at improving the graft stability on the first postoperative day. Patients and method Patients Our study was conducted as part of a decentralized surgical activity in a transportable hospital. The primary target was patients with cataracts, but pterygium also was operated on. Thus 77 eyes of 77 patients were operated from 09-07-2018 to 08-08-2018 Inclusion criteria *Correspondence to: Nganga Ngabou Charles Géraud Fredy, Department of Ophthalmology, University Hospital of Brazzaville, Brazzaville, Republic of Congo, E-Mail: fredygeraud@gmail.com