Refractive Outcomes of Simultaneous Pterygium and Cataract Surgery With Fibrin Glue.

Introduction Pterygium is commonly reported in India because of its tropical location. It is often accompanied by senile cataract. The current study aimed to evaluate the refractive outcomes of patients undergoing simultaneous pterygium and cataract surgery. Materials and methods A total of 12 patients with cataract and pterygium underwent simultaneous phacoemulsification with a foldable intraocular lens (IOL) followed by pterygium excision with conjunctival limbal autograft secured with fibrin glue under peribulbar anesthesia. Nasal pterygium was present in all the cases, and its size ranged from 2.5 to 3.5 mm from the limbus. All the patients exhibited nuclear sclerotic cataract of grades 2 and 3. Results The results of the patients were analyzed retrospectively. We determined the best-corrected visual acuity ([BCVA] in logMAR), manifest astigmatism, and mean corneal astigmatism before operation and after 12 months of surgery. We also analyzed the correlation between the prediction error (calculated by subtracting the predicted postoperative refraction from the actual postoperative spherical equivalent) and changes in the mean keratometry and prediction errors and pterygium size. The mean age of the patients was 61.9 ± 7.14 years (range: 50-70 years). The mean BCVA at presentation was 0.67 ± 0.24 logMAR units, which significantly increased after surgery to 0.01 ± 0.03 logMAR units (p < 0.001, Wilcoxon signed-rank test). The mean manifest corneal astigmatism significantly reduced from -1.98 ± 0.84 diopters (D) preoperatively to -0.54 ± 0.18 D postoperatively (p < 0.001). Mean corneal keratometry increased from 43.81 ± 1.77 D preoperatively to 44.19 ± 1.76 D postoperatively (p < 0.05). At 12 months, 58.33% and 41.66% of the eyes were within  ±0.5 D and  ±1.0 D, respectively. A significant correlation was observed between the prediction errors and changes in the mean keratometry (Spearman signed-rank test, r = -0.65, p < 0.05) and pterygium size (Spearman correlation coefficient, r = -0.75, p < 0.05). Conclusion The simultaneous pterygium and cataract surgery with conjunctival autograft and fibrin glue was safe and effective in providing excellent and predictable refractive outcomes. Steepening of the cornea after combined surgery results in myopia; therefore, the IOL power should be selected appropriately. The use of fibrin glue in surgeries reduces the operative time and postoperative pain and results in early postoperative rehabilitation of patients.

Resolution of Corneal Dellen After an Uneventful Pterygium Surgery with Punctal Cautery.

Corneal dellen are a rare and serious complication after primary pterygium surgery with conjunctival limbal autograft (CLAG) with fibrin glue without antimetabolites. Dellen are caused by interruptions of the tear film and local dehydration of the cornea. If untreated, they may lead to corneal perforation. We describe the case of a patient who developed corneal dellen 15 days after uneventful pterygium excision with CLAG with fibrin glue without the use of antimetabolites. There was no satisfactory response to lubricants and patching, and the patient had no associated systemic risk factors. As the thinning increased, cyanoacrylate glue with bandage contact lens was applied, but the dellen reappeared seven days after glue removal. Dellen finally resolved with thermal punctal cautery applied to both puncta. Dellen most commonly respond to artificial tears, antibiotic ointment, and patch application. However, in refractory cases, punctal cauterization can be considered as a good option to increase tear pooling in the area of dellen, thereby promoting healing.