Original Research Article http://doi.org/ 10.18231/j.ijooo.2019.015 IP International Journal of Ocular Oncology and Oculoplasty, April-June 2019;5(2):55-60 55 Comparative analysis between blood clot conjunctival autografting (CAG) versus amniotic membrane (AMG) grafting on pterygium excision surgery Pankaj Soni 1* , Suroma Joysmine Marndi 2 , Ashutosh Kumar Singh 3 1 Associate Professor, 2 Senior Resident, 3 Junior Resident, Dept. of Ophthalmology, BRD Medical College, Gorakhpur, Uttar Pradesh, India *Corresponding Author: Pankaj Soni Email: joysmine1990@gmail.com Abstract Objective: To compare the efficacy and analyse between autologous blood clot limbal conjunctival autograft (CAG) with amniotic membrane grafting (AMG) on pterygium excision surgery. Materials and Methods: This study included 62 patients (18-70 years) with primary pterygium attending OPD in Dept. of Ophthalmology in our tertiary care hospital. It is a 1 year observational study(February 2018 to January 2019) with 6 months period of observation in post- operative patients of CAG and AMG groups in primary pterygium excision surgery and the results have been compared in the study. Results: The mean age group being 42 ± 7 years of total 62 patients with 54 male patients and 8 female patients with no drop out throughout the study. 38 patients were randomly selected for CAG group rest 24 patients were selected into AMG group. In 6 months of post-operative observation 2 (3.23%) patients in CAG group and 6 (9.68%) patients in AMG group had recurrence of pterygium while 1 patient had symblepharon in the intermediate period of observation in CAG group. Conclusion: The recurrence of pterygium (≥1mm) was more in amniotic membrane graft patient compared to autologous blood clot tenon free conjunctival autograft. Autologous blood clot conjunctival graft required more surgical skills, proper techniques and took more surgical time as compared amniotic membrane grafting, but BCAG more economical compared to AMG. Both CAG & AMG appears to be safe for excision of pterygium with fewer recurrence of pterygium. Keywords: Pterygium, Recurrence, Autologous blood clot conjunctival autograft, Amniotic membrane graft. Introduction Pterygium is a wing-shaped fibrovascular growth that extends from the conjunctiva onto the nasal, temporal or both (double pterygium) aspect of the cornea. The major contributor to formation of pterygium has been considered to be exposure to ultraviolet (UV) light. Early pterygium is usually asymptomatic. The main concern of a patient with pterygium is cosmetic disfigurement, while other being recurrent inflammation, visual impairment(due to induced astigmatism/ altered tear film layer), difficulty to wear contact lens and rarely diplopia from motility restriction by tenon capsule contraction. These were the indication for pterygium excision surgery. Pathogenesis – recent evidence implicates anti- apoptotic mechanism, cytokines, growth factors; extracellular matrix modulators, genetic factors and viral infections among other possible causative factor other than exposure to UV light. Excision surgery is the only known treatment for pterygium; however no technique has entirely prevented recurrence of pterygium, which is more pronounced in malignant pterygium than in a primary pterygium. The most common technique can be: 1) bare sclera excision 2) tissue grafting- conjunctival graft or amniotic membrane graft alone or grafting combined with mitomycin C (MMC). It has been reported that the risk of recurrence is about 25- 45% in cases with simple bare sclera technique 1 in certain population where the risk of recurrence is reduced by 5-15% with pterygium excision with tissue grafting. The higher rate of the recurrence have been explained by the theory of corneal limbal stem cell deficiency. Spaeth et al 2 in a study explained the modification of the surgical technique using conjunctival autograft for covering bare sclera after pterygium excision, which resulted in decrease recurrence rate. Kenyon et al 3 introduced the surgical technique using conjunctival autograft in the management of primary and recurrent pterygium. Tissue grafting is more time consuming and more difficult compared to bare sclera technique. Use of suture is an older technique with maximum surgical time and post-operative discomfort. Suture free methods- tissue adhesives fibrin glue or autologous blood clot method are now widely used surgical techniques with better outcome in pterygium surgeries. Autologous blood clot with tissue grafting is an effective alternative which is easily available, economical compared to fibrin glue with less surgical time and post-operative discomfort. Suture free tissue grafting were associated with graft reposition/loss, bleb formation, granuloma (tenon’s), rise in IOP, corneoscleral dellen formation, epithelial inclusion cyst. AMG had advantage over CAG in cases with advanced (grade IV) pterygium, bilateral heads or those who might need glaucoma surgery later. Adjunctive therapies along with pterygia excision- Beta irradiation, 5- flurouracil (5-FU) and MMC has been recommended due to their antifibrotic and angiogenic properties. Use of MMC has higher efficacy in reducing recurrency but it can be associated with vision threatening complications, including delayed conjunctival epithelisation leading to poor wound healing, scleral thinning and ulceration; there are evidence of increased complications with increased concentration and duration of exposure to MMC. Conjunctival/limbal conjunctival autograft was superior to amniotic membrane graft in reducing the rate of pterygium recurrence.