Fibrin tissue adhesive has benefits in pterygium surgery

Washington, DC-Fibrin tissue adhesive (Tisseel VH Fibrin Sealant, Baxter BioSurgery) is a viable and attractive alternative to suturing in pterygium surgery with conjunctival-limbal autograft, said John A. Hovanesian, MD, at the World Cornea Congress V.

In the first study, statistically significant differences favored fibrin tissue adhesive over sutures for shorter operative time (13 versus 21 minutes, respectively) and for lessening pain after surgery. While patients in 38% of sutured cases rated their pain as moderate to severe, only 4% of cases performed with the fibrin adhesive were associated with that level of pain. In addition, the proportion of cases associated with no pain was nearly two-fold greater in the fibrin tissue adhesive group versus in the eyes with sutures, 41% versus 23%, respectively.

"Pterygium surgery is frequently combined with use of a conjunctival-limbal autograft because that technique is associated with a low rate of recurrence. Unfortunately, sutures used to fix the graft can cause significant postoperative inflammation," said Dr. Hovanesian, clinical instructor, Jules Stein Eye Institute, UCLA, Los Angeles.

Attention to technique Dr. Hovanesian's technique for the surgery begins with a standard excision of the pterygium from the cornea and conjunctiva, taking no more than a 1-mm margin of normal conjunctiva. Then, a thin conjunctival autograft is taken from the superior limbus region using careful dissection to ensure an adequate complement of limbal stem cells is harvested while leaving Tenon's fascia in place as much as possible.

The harvested graft is inverted to lay epithelium against corneal epithelium, cut free with Vannas scissors, and moved in a limbus-to-limbus configuration near the bare sclera site.