Fibrin Glue Vs Sutures for Conjunctival Autografting in Pterygium Surgery
Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision.
Methods: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium.
Results: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) min (range 12-18 min) and in the suture group (p <0.001) it was 32.5 (6.7) min (range 25-40 min). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p <0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p <0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p <0.05).
Conclusion: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing.
Conjunctival autografting after pterygium excision is associated with very low rates of recurrence and complications when compared with other techniques. The surgeon's skill and experience affect the recurrence rate, which varies between 2% and 39% with this technique. Nevertheless, because of graft suturing, this method has the disadvantage of a relatively longer surgery time when compared with the bare sclera technique; also it carries the risk of complications such as granuloma formation and giant papillary conjunctivitis, as well as significant patient discomfort after surgery.
Because of its biological and biodegradable properties, fibrin-based adhesives may be used under a superficial covering layer (conjunctiva, amniotic membrane, etc) without inducing inflammation. Fibrin glues have been used in an array of ophthalmic procedures such as conjunctival closure in strabismus, vitreoretinal and glaucoma surgery. Tissue adhesives of different types had been used in previous studies to attach conjunctival grafts and, compared with the use of sutures, were associated with a shorter operative time and reduced postoperative complaints. However, the recurrence rates after the use of fibrin glue have been investigated in only a few studies, the results of which have been inconsistent.
In the present study, we sought to determine the safety and efficacy of using fibrin glue (Tisseel VH, Baxter AG, Vienna) to attach conjunctival autografts and to the results of such with the use of Vicryl sutures in patients undergoing pterygium excision. To do this, we planned a prospective, randomised study to evaluate operation time, postoperative patient comfort and pterygium recurrence.
Abstract and Introduction
Abstract
Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision.
Methods: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium.
Results: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) min (range 12-18 min) and in the suture group (p <0.001) it was 32.5 (6.7) min (range 25-40 min). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p <0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p <0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p <0.05).
Conclusion: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing.
Introduction
Conjunctival autografting after pterygium excision is associated with very low rates of recurrence and complications when compared with other techniques. The surgeon's skill and experience affect the recurrence rate, which varies between 2% and 39% with this technique. Nevertheless, because of graft suturing, this method has the disadvantage of a relatively longer surgery time when compared with the bare sclera technique; also it carries the risk of complications such as granuloma formation and giant papillary conjunctivitis, as well as significant patient discomfort after surgery.
Because of its biological and biodegradable properties, fibrin-based adhesives may be used under a superficial covering layer (conjunctiva, amniotic membrane, etc) without inducing inflammation. Fibrin glues have been used in an array of ophthalmic procedures such as conjunctival closure in strabismus, vitreoretinal and glaucoma surgery. Tissue adhesives of different types had been used in previous studies to attach conjunctival grafts and, compared with the use of sutures, were associated with a shorter operative time and reduced postoperative complaints. However, the recurrence rates after the use of fibrin glue have been investigated in only a few studies, the results of which have been inconsistent.
In the present study, we sought to determine the safety and efficacy of using fibrin glue (Tisseel VH, Baxter AG, Vienna) to attach conjunctival autografts and to the results of such with the use of Vicryl sutures in patients undergoing pterygium excision. To do this, we planned a prospective, randomised study to evaluate operation time, postoperative patient comfort and pterygium recurrence.
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