Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial

Abstract

Aims: To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery. Methods: Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardised digital slit-lamp photographs were taken at 1 week, 1 month and 3 months postoperatively. Sutures were masked using commercially available photoediting software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability. Results: 34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) postoperatively. No significant difference was found for inflammation at 1 week postoperatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076 and p = 0.624, at 1 week, 1 month and 3 months, respectively). No significant difference was found in degree of postoperative SCH between the groups (p = 0.417, p = 1 and p = 1, at 1 week, 1 month and 3 months, respectively). Conclusion: This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery not only are as stable as those secured with sutures, but also produce significantly less inflammation.The prevalence rate of primary pterygium varies from 0.7 to 31% in various populations around the world.

Pterygium surgery by means of conjunctival autograft: long term follow-up

“…However, polyglactin sutures caused slightly more conjunctival reactions in the early postoperative period than nylon sutures. The use of fibrin glue for attaching the conjunctival autograft in the surgical management of primary pterygium reduced surgical time and also conjunctival hyperemia and ocular discomfort compared to fixation with nylon 10/0 or with vicryl sutures; it proved an excellent option for conjunctival autograft attachment in primary pterygium surgery (6)(7)(8)(10)(11)(12)(13)(14)(15)(16)18,22,23,27) . Even so, its role with respect to traditional suturing is still a matter of debate.…”

“…The use of sutures may induce inflammation ad migration of Langerhans cells to the cornea (30) . A retrospective study (31) and a prospective (14) comparative studies showed statistically significant less degree of inflammation and decreased recurrence rate with fibrin glue use than sutures. The recurrence rate was not evaluated in many of the studies cited in which fibrin glue was used (7,9,12,14,16,18) .…”

“…The recurrence rate was not evaluated in many of the studies cited in which fibrin glue was used (7,9,12,14,16,18) . However, some studies have reported lower rates of recurrence when using fibrin glue (8,13,14,31,32) , while others have reported the same rate of recurrence as when using suturing (10,11,(15)(16)(17)33) . The majority of these studies have not been subjected to long time follow-ups and when such studies have been conducted, most of them have focused on periods of less than one year.…”

“…All of these studies concluded that the use of fibrin glue in pterygium surgery involving conjunctival autografting significantly reduces surgery time and improves postoperative patient comfort and cosmesis. Even so, there was no such consensus with respect to the question of recurrences and unfortunately, the recurrence rate was not evaluated in many of these studies (7,9,10,14,16,18) . Some studies did, however, demonstrate lower rates of recurrence when fibrin glue was used (8,13) , while in others, the same rate of recurrence was reported as associated with suturing (10,11,(15)(16)(17) .…”

“…Various different studies have compared the safety and recurrence rates of pterygium associated with the use of absorbable and non-absorbable sutures and the use of sutures and fibrin glue when making conjunctival autografts (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . All of these studies concluded that the use of fibrin glue in pterygium surgery involving conjunctival autografting significantly reduces surgery time and improves postoperative patient comfort and cosmesis.…”