Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts


Purpose: To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery.

Methods: We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm2) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence.

Results: The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm2) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4).

Conclusion: RS, by augmenting the autologous blood mechanism, may offer an easy-to-learn option for pterygium surgery with good stability even in large-sized CAGs.


Autologous Blood, Conjunctival Autograft, Pterygium, Recurrence, Releasable Suture

1. Duke-Elder S. Diseases of the outer eye. Syst Ophthalmol 1965;8:573–585.

2. Hirst LW. The treatment of pterygium. Surv Ophthalmol 2003;48:145–180.

3. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985;92:1461–1470.

4. Koranyi G, Seregard S, Kopp ED. The cut-and-paste method for primary pterygium surgery: long-term followup. Acta Ophthalmol 2005;83:298–301.

5. Chen PP, Ariyasu RG, Kaza V, LaBree LD, McDonnell PJ. A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 1995;120:151–160.

6. Uy HS, Reyes JM, Flores JD, Lim-Bon-Siong R. Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology 2005;112:667–671.

7. Ti SE, Chee SP, Dear KB, Tan DT. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol 2000;84:385–389.

8. Fan Xu, Min Li, Yumei Yan, Lu K, Cui L, Chen Q. A novel technique of sutureless and glueless conjunctival autografting in pterygium surgery by electrocautery pen. Cornea 2013;32:290–295.

9. Yasemin O, Seda M, Unsal H, Ileri D, Onal B, Ilhan O, et al. A comparative study of tissue glue and vicryl suture for closing limbal conjunctival autografts and histologic evaluation after pterygium excision. Cornea 2008;27:552–558.

10. Tan DH, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997;115:1235–1240.

11. Hernández- BE, Amescua G, Navas A, Garfias Y, Ramirez- Miranda A, Lichtinger A, et al. Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment. Br J Ophthalmol 2015;99:1598–1600.

12. Allan BD, Short P, Crawford GJ, Barrett GD, Constable IJ. Pterygium excision with conjunctival autografting: an effective and safe technique. Br J Ophthalmol 1993;77:698–701.

13. Tan D. Conjunctival grafting for ocular surface disease. Curr Opin Ophthalmol 1999;10:277–281.

14. Kurian A, Reghunadhan I, Nair KGR. Autologous blood versus fibrin glue for conjunctival autograft adherence in sutureless pterygium surgery: a randomised controlled trial. Br J Ophthalmol 2015;99:464–470.

15. D de Wit, I Athanasiadis, A Sharma. Sutureless and gluefree conjunctival autograft in pterygium surgery: a case series. Eye 2010;24:1474–1477.

16. Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Options and adjuvants in surgery for pterygium. Ophthalmology 2013;120:201–208.

17. Jiang J, Yang Y, Zhang M, Fu X, Bao X, Yao K. Comparison of fibrin sealant and sutures for conjunctival autograft fixation in pterygium surgery: one-year follow-up. Ophthalmologica 2008;222:105–111.

18. Karalezli A, Kucukerdonmez C, Akova YA, Altan-Yaycioglu R, Borazan M. Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study. Br J Ophthalmol 2008;92:1206–1210.

19. Foroutan A, Beigzadeh F, Ghaempanah MJ, Eshghi P, Amirizadeh N, Sianati H, et al. Efficacy of autologous fibrin glue for primary pterygium surgery with conjunctival autograft. Iran J Ophthalmol 2011;23:39–47.

20. Mitra S et al. Autoblood as tissue adhesive for conjunctival autograft fixation in pterygium surgery. Poster presented at the Annual Meeting of the American Academy of Ophthalmology. Orlando, FL; 2011.

21. Hirst LW, Sebban A, Chant D. Pterygium recurrence time. Ophthalmology 1994;101:755–758.