Amniotic Membrane Transplantation Using

Fibrin Glue in Pterygium Surgery

Sirel G. Gngr, MD
Cem Kkerdnmez, 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 deciency
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

18.7 +/- 2.2

11.2 +/- 3.4

p<0.05

Recurrence
rate (%)

5.8

5.5

p>0.05

Mean followup time

(months)

16.8 +/- 4.2

15.9 +/- 2.5

p>0.05

Mean
operation
time
(minutes)

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

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 Gr Gngr, 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, Bakent
University, School of
Medicine, Department of
Ophthalmology, Ankara,
Turkey

NAME: Cem Kkerdnmez, 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 : Bakent University, School of
Medicine,
Department of Ophthalmology

NAME: Yonca Aydn 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