Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial

Abstract

Introduction: Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. Aim: To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. Materials and Methods: It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow- up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. Results: The mean age of patients in group A was 48.32±14.3 years (21-65 years), and in group B was 54.48±15.67 (23-74 years). Mean operating time in group A was 23.21±9.4 minutes and 13.7±4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. Conclusion: This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue.

Use of Cryopreserved Amniotic Membrane During Pterygium Excision: Health Economic Analysis

“… 10 , 13 , 26 , 27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus. 10 , 12 , 13 , 17 , 18 , 24 , 27 Aside from one study that reported the use of autologous fibrin glue, 20 the fibrin glues used in the studies were commercially available products such as Tisseel ® (Baxter Healthcare Corporation, Glendale, CA) and FIBINGLURAAS ® (Shanghai RAAS Blood Products Co., Ltd, China). In the majority of the studies assessing CAU with sutures, the graft was anchored to the episclera and attached to the adjacent conjunctiva with interrupted 8–0 Vicryl sutures or 10–0 nylon sutures.…”

“…All studies were randomized controlled trials aside from four prospective comparative studies. [10][11][12][13] Eight studies compared the use of fibrin glue versus sutures, 12,[14][15][16][17][18][19][20] six studies compared CAU with fibrin glue to other treatment arms, 11,[21][22][23][24][25] and four studies compared CAU with sutures to other treatment arms. 10,13,26,27 In brief, the majority of studies harvested the CAU from the superotemporal quadrant of the bulbar conjunctiva, seven of which reported the use of conjunctival limbal autograft to include part of the superficial limbus.…”

“…Of 796 eyes/cases that underwent pterygium excision and CAU with fibrin glue, the weighted average duration of surgery was 23.6 minutes (Table 1). 11,12,[14][15][16][17][18][19][20][21][22][23][24][25] Twelve studies reported the surgical duration for CAU with sutures, with an average operative time of 38.1 minutes among 640 eyes (Table 2). 10,[12][13][14][15][16][17][18][19][20]26,27 previously reported, the average operative time for pterygium excision using the TissueTuck technique is 14.7 minutes.…”