الفهرس 
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Abstract
Pterygium is a benign non-cancerous growth of the conjunctiva that lays over the sclera (Bradley, et al 2010).
It can significantly alter visual function in advanced cases and become inflamed, leading to redness and irritation in the area. In addition, the pterygium has the potential to progress to some ocular cancers, including ocular surface squamous neoplasia(Yeung, et al 2011).
It is a potentially blinding disease in the advanced stage when it encroaches visual axis, which can have significant impact on vision and require surgery for visual rehabilitation (Lu , Chen 2009 ).
Pterygium has a worldwide distribution though it is considered more common in warm, dry climates with a reported prevalence as high as 22% in equatorial areas and less than 2% in latitudes above 40 degrees (Viso, et al 2011).
Although environmental factors appear to be the dominant cause of pterygium, tear film abnormalities are also incriminated in its theories of aetiopathogenesis(Onkar, et al 2017). It is speculated to be associated with corneal and conjunctivalmicrotrauma from exposure to sunlight and/or dust (Zhong, et al 2016).
There are a variety of options for the management of pterygium . There is currently no reliable medical treatment to reduce or even prevent pterygium progression .The definitive treatment is achieved by surgical excision (Frucht-Pery, et al 2006).
The ideal treatment has low recurrence and complication rates and excellent cosmetic. While a large variety of techniques are described in the literature, no single procedure is considered to be best for all situations.Adjuvant therapies have become an important part of pterygium surgical management and we use it to reduce the recurrence but not all have been able to effectively reduce recurrence.
Pterygium excision with conjunctivalautograft has exhibited good results because it maintains the ocular surface even and restores the anatomy which existed before the corneal invasion caused by the pterygium, anchoring the denuded scleral bed with sutures such as Vicryl or by means of tissue glues (Tissue adhesive) Both techniques yield excellent results for reducing the number of recurrences in this type of surgery. In addition, patients comfort for the first few days after surgery is also an important factor in this type of intervention. Pterygium excision with autologous conjunctival grafting seems to be the best method, giving both low recurrence rate and high safety (Bhatia, et al 2017).
Suturing is a time consuming process for which surgeons are in search of an ideal alternative. An ideal suture is one which is easy to handle, non-allergenic, affordable and does not promote infection. Besides, none of the sutures currently available fulfill the requirements of an ideal suture (Dumville, et al 2014).
The most commonly used tissue adhesive glue in ophthalmology is Tisseel Duo Quick, which is a two-component tissue adhesive that mimics the natural fibrin formation, and it is prepared from banked human blood. Risk of transmission of prion disease and risk of anaphylaxis in susceptible individuals are main limiting factor in glue method of treatment (Koranyi, et al 2004).
Autologous cryoprecipitate may be superior to commercial products since it probably reduces the risk of transfusion transmitted diseases. It has two modes of action: Sealing the wound and acting as a hemostatic agent so in this study was conducted to compare between the use of autologus cryoprecipitate and the use of absorbable sutures in securing the conjunctivalautograft (CAG) at the surgical site after excision of the ptrygium ,postoperative inflammation and the efficacy in reduction the recurrence rate.
The study was carried out to prove the efficacy of autologous Cryoprecipitate for attaching conjunctivalautografts after primary pterygium excision , reduce the recurrence rate and reduce he postoperative inflammation.
The study included 50 patients with primary pterygium collected from outpatient clinc of National Eye Center Rod El Farag. They were divided into two groups:
group A: 25 patients were managed by Pterygium excision with free conjunctivalautograft using autologous cryoprecipitate.
group B: 25 patients were managed by Pterygium excision with free conjunctivalautograft using vicryl absorbable sutures 8/0.
Results:On comparing the two patients groups (the glue group and the suture group) The median operation duration was statistically significantly lower in the glue group, compared to the suture group (p value= <0.001). There is statistically significant difference in postoperative pain, lacrimation, subconjunctival haemorrhage which is lower in the glue group. And no significant difference between the 2 groups in the recurrence rate.
Conclusion:The use of autologous cryoprecipitate to attach the free conjunctivalautograft in pterygium surgery is as effective as standard fibrin glue for autograft fixation in pterygium surgery. Appeared to be safe, reliable, quick and there were no infections and severe related complications after 6 months follow-up. It produced less post-operative pain, and it required shorter surgical time, compared with conventional pterygium surgery. Further evaluation of the safety and recurrence rate will be carried out with a larger series.