International Ophthalmology

, Volume 34, Issue 1, pp 75–79 | Cite as

The influence of pterygium morphology on fibrin glue conjunctival autografting pterygium surgery

  • Sekelj SandraEmail author
  • Janjetovic Zeljka
  • Vukovic Arar Zeljka
  • Samardzic Kristian
  • Aric Ivana
Original Article


To evaluate the influence of pterygium morphology on the efficacy and safety of fibrin glue in pterygium surgery with conjunctival autografting. A prospective case series. During a period of 15 months, 45 patients (51 eyes) were recruited from the General Hospital for pterygium surgery. Seven eyes (13.73 %) were operated on for a recurrent pterygium. Autologous conjunctiva was harvested from the superior bulbar conjunctiva and fixed with fibrin glue. The pterygia were preoperatively divided into atrophic/grade 1 (n = 18; 35.29 %), intermediate/grade 2 (n = 22; 43.14 %) or fleshy/grade 3 (n = 11; 21.57 %) according to clinical morphology. Patients were evaluated for intraoperative and postoperative complications and recurrence rates. The success rate was defined by no pterygium recurrences. Patients with 2-year follow-ups were included in this study. Fifty-one patients (21 females/30 males) with a mean age of 60–65 years (range 24–87 years) took part in the study. All patients completed the study. No intraoperative complications were noted. Postsurgical complications included graft edema (n = 4; 7.8 %), graft hyperemia (n = 2; 3.8 %), and graft dislocation (n = 3; 5.9 %); these complications were transient. One graft unfastened completely (2 %) and five pterygium recurrences occurred (n = 5; 9.8 %). The overall success rate was 90 % after 2 years. In grade I group there were no recurrences, in grade 2 group there were two recurrences, and in grade 3 group there were three recurrences. There were significantly more recurrences in grade 3 group than in grade 2 group. There were more recurrences in both groups than in group 1 (60 vs 40 vs 0 % of all recurrences, p ≤ 0.05). The use of fibrin glue is a safe, easy and effective technique for attaching the conjunctival autograft in pterygium surgery. The morphology of pterygium influences recurrence rates, without significance for intraoperative and postoperative complications.


Pterygium Morphology Autologous graft Fibrin glue 


Conflict of interest

The authors have no commercial interest in any of the materials discussed in this article.


  1. 1.
    Pan HW, Zhong JX, Jing CX (2011) Comparison of fibrin glue versus suture for conjunctival autografting in pterygium surgery: a meta-analysis. Ophthalmology 118(6):1049–1054PubMedCrossRefGoogle Scholar
  2. 2.
    Saw SM, Tan D (1999) Pterygium: prevalence, demography and risk factors. Ophthalmic Epidemiol 6(3):219–228PubMedCrossRefGoogle Scholar
  3. 3.
    Sekelj S, Dekaris I, Kondza-Krstonijević E et al (2007) Ultraviolet light and pterygium. Coll Antropol 31(Suppl 1):45–47PubMedGoogle Scholar
  4. 4.
    Chowers I, Pe’er J, Zamir E et al (2001) Proliferate activity and p53 expression in primary and recurrent pterygium. Ophthalmology 108:985–988PubMedCrossRefGoogle Scholar
  5. 5.
    Mutlu FM, Sobaci G, Tatar T et al (1999) A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology 106(4):817–821PubMedCrossRefGoogle Scholar
  6. 6.
    Nowell JF (1992) Beta irradiation of pterygium. Ophthalmology 99(6):841–842PubMedCrossRefGoogle Scholar
  7. 7.
    Manning CA, Kloess PM, Diaz MD et al (1997) Intraoperative mitomycin in primary pterygium excision. Ophthalmology 104(5):844–848PubMedCrossRefGoogle Scholar
  8. 8.
    Ti SE, Tseng SC (2002) Management of primary and recurrent pterygium using amniotic membrane transplantation. Curr Opin Ophthalmol 13(4):204–212PubMedCrossRefGoogle Scholar
  9. 9.
    Mahar PS (1997) Conjunctival autograft versus topical mitomycin C in treatment of pterygium. Eye 11:790–792PubMedCrossRefGoogle Scholar
  10. 10.
    Cohen RA, McDonald MB (1993) Fixation of conjunctival autograft with an organic tissue adhesive (letter). Arch Ophthalmol 111:1167–1168PubMedGoogle Scholar
  11. 11.
    Korany G, Seregard S, Kopp ED (2004) Cut and paste: a no suture small incision approach to pterygium surgery. Br J Ophthalmol 88:911–914CrossRefGoogle Scholar
  12. 12.
    Ayala M (2008) Results of pterygium surgery using a biologic adhesive. Cornea 27(6):663–667PubMedGoogle Scholar
  13. 13.
    Farid M, Pirnazar JR (2009) Pterygium recurrence after excision with conjunctival autograft: a comparison of fibrin tissue adhesive to absorbable sutures. Cornea 28(1):43–45PubMedCrossRefGoogle Scholar
  14. 14.
    Ozdamar Y, Mutevelli S, Han U et al (2008) A comparative study of tissue glue and vicryl suture for closing limbal–conjunctival autografts and histologic evaluation after pterygium excision. Cornea 27(5):552–558PubMedCrossRefGoogle Scholar
  15. 15.
    Al Fayez MF (2002) Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 109(9):1752–1755PubMedCrossRefGoogle Scholar
  16. 16.
    Nieuwendaal CP, Van der Meulen IJE, Mourits M et al (2011) Long-term follow-up of pterygium surgery using a conjunctival autograft and Tissucol. Cornea 30:34–36PubMedCrossRefGoogle Scholar
  17. 17.
    Por YM, Tan DTH (2010) Assessment if fibrin glue in pterygium surgery. Cornea 29:1–4PubMedCrossRefGoogle Scholar
  18. 18.
    Srinuvasan S, Dollin M, McAllum P et al (2009) Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial. Br J Ophthalmol 93:215–218CrossRefGoogle Scholar
  19. 19.
    Panda A, Kumar S, Kumar A et al (2009) Fibrin glue in ophthalmology. Indian J Ophthalmol 57(5):371–379PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Schlag G, Aschler PW, Steinkogler FJ et al (1994) Fibrin sealing in surgical and nonsurgical fields. Vol. 5. Neurosurgery, ophthalmic surgery, ENT. Springer, BerlinCrossRefGoogle Scholar
  21. 21.
    Bhatia SS (2006) Ocular surface sealants and adhesives. Ocul Surf 4(3):146–154PubMedCrossRefGoogle Scholar
  22. 22.
    Biedner B, Rosenthal G (1996) Conjunctival closure in strabissmus surgery: vicryl versus fibrin glue. Ophthalmic Surg Laser 27(11):967Google Scholar
  23. 23.
    Kajiwara K (1990) Repair of a leaking bleb with fibrin glue. Am J Ophthalmol 109(5):599–601PubMedGoogle Scholar
  24. 24.
    Mentens R, Stalmans P (2007) Comparison of fibrin glue and sutures for conjunctival closure in pars plana vitrectomy. Am J Ophthalmol 144(1):128–131PubMedCrossRefGoogle Scholar
  25. 25.
    Tan DT, Chee SP, Dear KB et al (1997) Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 115(10):1235–1240PubMedCrossRefGoogle Scholar
  26. 26.
    Sebban A, Hirst LW (1991) Pterygium recurrence rate at the Princess Alexandra Hospital. Aust N Z J Ophthalmol 19(3):203–206PubMedCrossRefGoogle Scholar
  27. 27.
    Hirst LW (2003) The treatment of pterygium. Surv Ophthalmol 48:145–180PubMedCrossRefGoogle Scholar
  28. 28.
    Kenyon KR, Wagoner MD, Hettinger ME (1985) Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 92:1461–1470PubMedCrossRefGoogle Scholar
  29. 29.
    Ang LP, Chua JL, Tan DT (2007) Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol 18(4):308–313PubMedCrossRefGoogle Scholar
  30. 30.
    de Wit D, Athanasiadis I, Sharma A, Moore J (2010) Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series. Eye 24(9):1474–1477PubMedCrossRefGoogle Scholar
  31. 31.
    Hall RC, Logan AJ, Wells AP (2009) Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts. Clin Experiment Ophthalmol 37(6):584–589PubMedCrossRefGoogle Scholar
  32. 32.
    Uy HS, Reyes JM, Flores JD et al (2005) Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology 112(4):667–671PubMedCrossRefGoogle Scholar
  33. 33.
    Jiang J, Yang Y, Zhang M et al (2008) Comparison of fibrin sealant and sutures for conjunctival autograft fixation in pterygium surgery: one-year follow-up. Ophthalmologica 222(2):105–111PubMedCrossRefGoogle Scholar
  34. 34.
    Karalezli A, Kucukerdonmez C, Akova YA et al (2008) Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study. Br J Ophthalmol 92(9):1206–1210PubMedCrossRefGoogle Scholar
  35. 35.
    Ratnalingam V, Eu AL, Ng GL et al (2010) Fibrin adhesive is better than sutures in pterygium surgery. Cornea 29(5):485–489PubMedCrossRefGoogle Scholar
  36. 36.
    Suzuki T, Sano Y, Kinoshita S (2000) Conjunctival inflammation induces Langerhans cell migration into the cornea. Curr Eye Res 21(1):550–553PubMedCrossRefGoogle Scholar
  37. 37.
    Chen PP, Ariyasu RG, Daza V et al (1995) A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 120:151–160PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Sekelj Sandra
    • 1
    Email author
  • Janjetovic Zeljka
    • 1
  • Vukovic Arar Zeljka
    • 1
  • Samardzic Kristian
    • 1
  • Aric Ivana
    • 1
  1. 1.Department of OphthalmologyGeneral Hospital Dr. J. BencevicSlavonski BrodCroatia

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