Amniotic Membrane Transplantation Using Fibrin Glue in Pterygium Surgery

1
Amniotic Membrane Transplantation Using Fibrin
Glue in Pterygium Surgery

• Sirel G. Güngör, MD
• Cem Küçükerdönmez, MD
• Yonca A. Akova, MD
• Baskent University, School of Medicine Department
  of Ophthalmology, Ankara Turkey

The authors acknowledge no financial interest in
the subject matter of this presentation
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Introduction

• Amniotic membrane transplantation (AMT) is a
  therapeutic option for ocular surface disorders
• Persistent epithelial defects
• Deep stromal defects
• Stem cell de?ciency
• Pterygium
• Symblepharon

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Purpose

• To evaluate the efficacy and safety of fibrin
  glue fixation of amniotic membrane and to compare
  the results with suture fixation in surgery for
  primary pterygium

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Methods

• Prospective, randomized clinical study of 40 eyes
  (40 patients) with primary pterygium divided into
  2 groups
• Surgical method
• Extensive pterygium removal and AMT

• Group 1
• Amniotic membrane was fixated with 8/0 Vicryl
  sutures
• Group 2
• Fibrin glue (Tisseel VH, Baxter AG, Vienna,
  Austria) was used

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Methods

• Clinical examination and digital photographing
  was performed at each visit
• Operation time, subjective sensation of pain,
  complications and recurrence rates were recorded

• Subjective pain scale
• 0 none, no pain
• 1 very mild, presence of pain but easily
  tolerated
• 2 mild, pain causing some discomfort
• 3 moderate, pain that partially interferes with
  usual activity or sleep
• 4 severe, pain that completely interferes with
  usual activity or sleep

Lim-Bon-Siong et al. Am J Ophthalmol 1998
125169
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Results
  Group 1 Group 2 p
Mean operation time (minutes) 18.7 /- 2.2 11.2 /- 3.4 plt0.05
Recurrence rate () 5.8 5.5 pgt0.05
Mean follow-up time (months) 16.8 /- 4.2 15.9 /- 2.5 pgt0.05
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Results

• In group 2
• Significantly less symptoms at postoperative day
  1 and 7
• Postoperative signs of hyperemia and chemosis
  were significantly less observed
• 2 eyes developed graft dehiscence after surgery,
  which were successfully re-fixated with fibrin
  glue
• No other complications were observed

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Preoperative primary pterygium
Clear cornea after extensive pterygium removal
and AMT with fibrin glue at 1st day
Clear cornea after extensive pterygium removal
and AMT with fibrin glue at 1st month
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Preoperative primary pterygium
Clear cornea after extensive pterygium removal
and AMT with 8/0 Vicryl sutures at 1st day
Clear cornea after extensive pterygium removal
and AMT with 8/0 Vicryl sutures at 1st month
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Discussion

• AMT with sutures
• Prolonged operating time
• Postoperative discomfort
• Suture-related complications such as abscess and
  granuloma formation
• AMT with fibrin glue
• Completely biodegradable
• Easy to fixate the amniotic membrane and shorter
  operation time
• Less patient discomfort

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Conclusion

• Fixation of amniotic membrane using fibrin glue
• Effective and safe method
• Reduced the operation time
• Improved postoperative comfort
• No additional effect on reducing pterygium
  recurrence

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NAME Yonca Aydin Akova, M.D. TITLE Professor in
Ophthalmology DATE AND PLACE OF BIRTH October
21, 1960, Turkey 1983 Doctor of Medicine,
Istanbul University, School of Medicine 1990
Istanbul University, School of Medicine,
Department of Ophthalmology 2000Professor of
Ophthalmology, Baskent University, School of
Medicine, Department of Ophthalmology, Ankara,
Turkey 2002 Chairperson, Baskent University,
School of Medicine, Department of Ophthalmology,
Ankara, Turkey
NAME Sirel Gür Güngör, M.D. TITLE Resident in
Ophthalmology DATE AND PLACE OF BIRTH February
15, 1979, Turkey 2003 Doctor of Medicine,
Ankara University, School of Medicine 2003-2008
Resident, Baskent University, School of
Medicine, Department of Ophthalmology, Ankara,
Turkey
NAME Cem Küçükerdönmez, M.D. TITLE Fellow in
Ophthalmology DATE AND PLACE OF BIRTH October
9, 1975, Turkey 1999 Doctor of Medicine,
Hacettepe University, School of Medicine 2003
Baskent University, School of Medicine,
Department of Ophthalmology