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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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
: 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