Cut and Paste Method for Pterygium Autograft Surgery
In this pterygium surgery case, James Lewis, MD, presents his approach to attaching an autologous conjunctival graft with adhesive. Following blunt dissection of the pterygium head, the conjunctival graft is excised from the same eye and slid nasally with the epithelium side down. The components of Tisseel glue (Baxter, Vienna, Austria) are applied in separate steps to the scleral bed and graft. The tissue is then carefully folded over.
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Comments (11)
Yes, the Tisseel folks have been told to act like Colonel Klink. There are two flavors of TIsseel, one that requires "cooking" before use (the one I prefer), and the instant. In the former, you get "thick" and "thin" components, put the thick down on the scleral and place thin on the back of the graft. Lay it down, wait a bit, smooth it and don't worry about tissue loss.
how do you separate the 2 components of the Tisseal? my rep states he can't guide me on this because it is off label.....
In cases without limbal cell dysfunction or deficiency there is no need to align the limbal cells. Given the area in which the autograft was harvested I doubt it contained any limbal cells. A more careful alignment is probably necessary in sicker eyes.
I noticed that you didn't worry about lining up the limbal edge of the graft with the limbal edge of the bed. I was taught that this is an important step because of the limbal stem cells. Can you comment?
No need for sutures! I have also used this technique with amniotic membrane without incident. It is a leap of faith but once you leave the sutures behind you will be free forever. You patients will be much happier and more comfortable.
Hi! Have you ever had problems with displacement of the graft? Shouldn´t we at least have 3-4 sutures?
DEAR SIR
I checked with my surgery center, part of the Wills Eye Surgical Network. They said that there was no additional reimbursement for Tisseel but that the sutures used instead were expensive also. They suggested bringing this issue up when contracts with carriers are renewed.
I have tried tisseel in the past but have had difficulty getting reimbursed for the product at our surgery center in the past. Any suggestions for getting reimbursed if we try to implement this again. Also what is your dislocation rate with grafts using this technique?
I agree entirely; amniotic membrane is a great option AND it works very well with Tisseel.
I agree Tisseel has made my life easier but don't dicard the advantages of amniotic membrane grafting in reducing recurrences.