Autologous Glue: Novel Use of Injectable Platelet-Rich Fibrin With Tranexamic Acid to Achieve Graft Adhesion in Pterygium Surgery.

PURPOSE: To study the use of autologous injectable platelet-rich fibrin (iPRF) and tranexamic acid (TA) for conjunctival autograft (CAG) adherence during pterygium surgery.

METHODS

This case series report included 212 primary nasal pterygiums from 205 patients who underwent pterygium excision with conjunctival autograft fixation using iPRF and TA operated by a single surgeon at 1 center. Surgical time, postoperative graft stability, and recurrence were assessed, and outcomes were compared with literature reports of autologous blood (ATB) and commercial fibrin glue (FG).

RESULTS

The average age was 57.8 years (range 33-75 years). The average surgical duration was 15.3 minutes (12.2-21.4 minutes). Graft dislodgement was noted in 1 eye (0.47%) on day 1, requiring reprocedure. Recurrence was observed in 2 patients (0.94%), mild graft edema in 68 eyes (32.07%), late spontaneous hemorrhage under CAG in 34 eyes (16%), and graft retraction in 2 eyes (0.94%). No postoperative infections, local inflammation, thrombotic complications, or systemic adverse effects were observed. The recurrence rates were lower than those reported for ATB. Unlike FG, iPRF contains platelets and leukocytes, which contribute to angiogenesis and wound healing. The addition of TA stabilizes the fibrin network by inhibiting fibrinolysis, thereby enhancing the adhesion. The cost incurred when using iPRF was 50x lower than that of Baxter Tisseel.

CONCLUSIONS

iPRF combined with TA is a safe, autologous, and cost-effective alternative to ATB, sutures, and FG for CAG fixation in pterygium surgery. Larger randomized controlled trials are required to validate the findings of this novel method.