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

Introduction Amniotic membrane transplantation (AMT) is a therapeutic option for ocular surface disorders Persistent epithelial defects Deep stromal defects Stem cell deficiency Pterygium Symblepharon

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

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

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; 125:169

Results Group 1 Group 2 p 18.7 +/- 2.2 11.2 +/- 3.4 p<0.05 5.8 5.5   Group 1 Group 2 p Mean operation time (minutes) 18.7 +/- 2.2 11.2 +/- 3.4 p<0.05 Recurrence rate (%) 5.8 5.5 p>0.05 Mean follow-up time (months) 16.8 +/- 4.2 15.9 +/- 2.5

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

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

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

Discussion AMT with sutures AMT with fibrin glue 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

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

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, Başkent 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 : Başkent University, School of Medicine, Department of Ophthalmology NAME: Yonca Aydın 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 2000:Professor of Ophthalmology, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey 2002: Chairperson, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey