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ORIGINAL ARTICLE
Year : 2021 | Volume
: 28
| Issue : 4 | Page : 208-210
Sutureless versus suture technique for conjunctivolimbal autografting in primary pterygium excision: A prospective study
Shimna C Prasad, Sheldon J Goudinho, Shela M Isaac, Susha G Sumangala
Department of Ophthalmology, Dr. Somervell Memorial CSI Medical College, Thiruvananthapuram, Kerala, India
Correspondence Address:
Dr. Shimna C Prasad
Department of Ophthalmology, Dr. Somervell Memorial CSI Medical College, Parassala Vellarada Road, Karakonam, Thiruvananthapuram - 695 504, Kerala
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/meajo.meajo_533_20
Abstract
PURPOSE: Conjunctivolimbal autograft is proposed to be the best treatment for pterygium and autograft can be fixed either with sutures or without. This study was undertaken to assess and compare the efficacy of sutureless versus suture techniques for conjunctivolimbal autografting in primary pterygium.
METHODS: A prospective observational study was conducted in the department of ophthalmology in a tertiary care center from March 2018 to September 2019. Twenty consecutive patients in the age group of 20 to 70 years with primary pterygium were included. Ten patients underwent suture technique for autograft placement, whereas ten patients underwent sutureless technique. Comparison of both the groups was done in terms of duration of surgery and postoperative symptoms. Data were entered into Microsoft Excel software and analyzed using SPSS software.
RESULTS: In the first group, the mean duration of surgery was 48 min and it was 38 min in the second group. The difference was statistically significant (P = 0.000). Postoperatively, foreign-body sensation was present in nine patients in the first group, whereas it was absent among the patients in the second group. The difference was statistically significant (P = 0.000). Four patients in the first group and two patients in the second group had postoperative hyperemia and only one patient in the first group had conjunctival chemosis. A graft-related complication was present in one patient in the second group.
CONCLUSION: Sutureless technique is a better technique as compared to conventional suture technique.
Keywords: Conjunctivolimbal autograft, suture technique, sutureless technique
Introduction 
Ultraviolet radiation exposure can lead to a group of diseases called ophthalmoheliosis,[1] which includes photokeratitis, pterygium, and pinguecula, of which one of the most common presentations is the pterygium.[2] In India, the prevalence of pterygium is more in rural areas ranging from 9.52% to 13%.[3],[4] Pterygium occurs in the interpalpebral region as a wing-shaped fibrovascular overgrowth of subconjunctival tissue and Tenon's capsule.[5] Bowman's membrane and superficial layers of the stroma are destroyed as it proliferates onto the cornea and causes ocular irritation, watering, redness, and decreased vision.[6] The most popular treatment for pterygium is conjunctivolimbal autograft which includes limbal stem cells that acts as a barrier to the conjunctival cells from migrating onto the corneal surface, thus preventing its recurrence.[7],[8],[9] Autograft can either be fixed with sutures or without sutures. This study was conducted to assess the efficacy of sutureless technique over suture technique.
Methods A prospective observational study was conducted in the department of ophthalmology in a tertiary care center in South India from March 2018 to September 2019 after obtaining approval from the scientific and ethical committee. A sample size of twenty was estimated using the formula 
Consecutive patients in the age group of 20 to 70 years with primary pterygium who were willing for surgical excision were included in the study. Patients with recurrent pterygium, pseudopterygium, conjunctivitis, and history of previous ocular surgery were excluded.
After noting the history and routine ophthalmic examination, pterygium excision with conjunctivolimbal autografting using suture technique was done for the first half of the patients, and glue-free sutureless technique was done for the other half. Duration of surgery was noted in both groups peroperatively, and symptoms and signs were assessed at each follow-up visit up to 6 weeks postoperatively. Postoperative complaints of patients were noted, and thorough ophthalmic examinations were done for each follow-up. Data were recorded using Microsoft Excel software and analyzed using IBM SPSS Version 20 software.
Results Twenty patients were included in this study, of which ten underwent pterygium excision with conjunctivolimbal autografting using suture technique and ten underwent sutureless technique. Oof twenty patients, there were 14 (70%) females and six (30%) males in the age group of 20 to 70 years. There were nine (45%) females and one (5%) male in the suture technique group, whereas in the sutureless technique group, there were five (25%) females and five (25%) males. Gender distribution is shown in [Figure 1].
In the suture technique group, the duration of surgery ranged from 45 to 55 min with a mean of 48 min, whereas it ranged from 35 to 40 min in the sutureless technique group with a mean of 38 min and the difference was statistically significant (P = 0.000). Comparison of duration of surgery among the groups is shown in [Figure 2].
Nine patients in the suture technique group complained of foreign-body sensation postoperatively, whereas none of the patients in the sutureless technique group had foreign-body sensation, and the difference was statistically significant (P = 0.000). Four patients in the suture technique group and two patients in the sutureless technique group had postoperative hyperemia, but the difference was not statistically significant (P = 0.628).
Conjunctival chemosis was seen postoperatively in one patient in the suture technique group, but none of the patients in the sutureless technique group had chemosis. The difference was not statistically significant (P = 1.000). Graft-related complication was present in one patient in the sutureless technique group, whereas none of the patients in the suture technique group had such complications, and the difference was not statistically significant (P = 1.000). [Table 1] shows the comparison of postoperative symptoms and signs among the groups.
Table 1: Comparison of postoperative symptoms and signs among the groups Discussion Management of pterygium still remains a surgical challenge even though various techniques have evolved over time, and the most dreaded complication encountered with most of the techniques is recurrence. Excision of pterygium with conjunctivolimbal autografting remains the standard technique of choice as conjunctivolimbal autografting re-establishes the barrier function of the limbus, which, in turn, reduces recurrence.[5] Autograft can be fixed with sutures, glue, or glue-free sutureless technique.
The primary objective of our study was to analyze the efficacy of sutureless technique, and nine had postoperative foreign-body sensation till 3rd week of follow-up technique over suture technique of conjunctivolimbal autografting in patients with primary nasal pterygium undergoing excision. Of the 10 patients who underwent suture technique, 9 had postoperative foreign body sensation till third week of follow up whereas in sutureless technique, none had foreign body sensation, and this was found to be statistically significant (P=0.001). Other complications such as hyperemia, chemosis, and graft-related complications were almost comparable in both the groups and were not statistically significant.
In a study done on fifty eyes by Sharma et al., in which 25 underwent sutureless glue-free conjunctival autograft and the other 25 underwent conventional suture technique, it was found that the mean surgical time was statistically significantly lesser in the first group as compared to the second group (P = 0.001). The sutureless technique group also had less postoperative symptoms as compared to the suture technique group.[5] These findings were consistent with our study.
Another important factor to be considered is the cost of surgery. The material cost of the sutureless technique is significantly lower than that of the suture technique or glue technique, as the fibrin glue or suture material can cost an additional expense for the patient. In a study done by Bhatia et al., 205 patients underwent the cut-and-paste technique of pterygium excision with autograft without using sutures or glue.[10] They found that the sutureless technique significantly shortens the duration of surgery, and it was also cost-effective which was consistent with our study. There are only a few studies in literature which compared the efficacy of sutureless technique over suture technique in terms of duration of surgery and postoperative findings.
Conclusion Our study proves that the sutureless technique is time and cost-effective and is better than the conventional suture technique in terms of postoperative symptoms and signs. Thus, the sutureless technique helps in providing more patient comfort, which will allow them to quickly return to their normal life.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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