Abstract
Abstract Objective: to compare nylon, fibrin glue and Vicryl® in the conjunctival autograft for treatment of primary pterygium. Methods: Prospective study approved by the Ethics Committee following the Declaration of Helsinki. 89 eyes were underwent pterygium excision and conjunctival autograft. They were grouped according to the technique: fibrin glue, nylon 10-0 and 8-0 Vicryl® and followed up for 3 months. Surgical Time, intra and postoperative symptoms, biomicroscopic signs, ocular discomfort ( by Visual Analogue Scale), aesthetic appearance and recurrences (day 21, 90 and 3 years) were evaluated. Results: The operative time was shorter with the fibrin glue (p<0.001). As to intraoperative symptomatology, burning sensation predominated with Vicryl® (p=0,012). The postoperative symptoms and signs: on day 1- secretion with fibrin glue (p=0.02), foreign body sensation (p=0.017) and subconjunctival hemorrhage (p=0.022) with Vycril®; on day 7- chemosis (p=0.035), hyperemia (p<0.001) and eyelid edema (p=0.011) with Vicryl®; on day 21-foreign body sensation (p=0.001) and conjunctival hyperemia (p<0.001) with nylon; on day 90- dry eye (p=0.005) with Vicryl®. Ocular discomfort was greater with Vycril® (p=0.015) on day 7. Final aesthetic appearance was superior with fibrin glue (p=0.003). The recurrences was greater on day 90: 20,7%(nylon), 10%(fibrin glue) and 19%(Vicryl®) (p=0.496) and after 3 years: 4.8% in NG, 0% in FGG, and 5.3% in VG (p=0.536). Conclusion: Fibrin glue showed efficacy, rapidity, less postoperative discomfort and better final aesthetic appearance. Vicryl® showed significant intraoperative and early postoperative symptoms and obvious signs of inflammation, beside ocular discomfort on day 7. Nylon caused more foreign body sensation and conjunctival hyperemia until its removal. The signs of recurrence were similar among the groups.
Highlights
Pterygium is a recurrent condition characterized as a benign, fibrovascular lesion that invades the cornea and can be surgically treated(1)
A prospective comparative study of 89 eyes (88 patients) with primary pterygium operated between January and August 2012, at Hospital Universitário Lauro Wanderley (HULW) – João Pessoa/PB – Brazil, was approved by the HULW Human Research Ethics Committee (Project number 439/11), in compliance with the principles of the Declaration of Helsinki
The patients were assigned to 3 groups with an equivalent number of participants each, according to the material used in the conjunctival graft fixation technique: Nylon Group (NG) - nylon 10.0 suture (Mononylon®, Ethicon, São Paulo, Brazil), Fibrin Glue Group (FGG) - biological fibrin glue (Tissucol®, Baxter AG, Vienna, Austria), and Vicryl® Group (VG) - polyglactin 8.0 (Vicryl®, Ethicon, São Paulo, Brazil)
Summary
Pterygium is a recurrent condition characterized as a benign, fibrovascular lesion that invades the cornea and can be surgically treated(1). Its main symptoms are foreign-body sensation, dry eye, burning sensation and, at advanced stages, high astigmatism and visual loss. The most common signs are conjunctival hyperemia, and, occasionally, punctate keratitis(2). The treatment of choice for pterygium is the excision of the fibrovascular lesion coupled with conjunctival autotransplantation(3). The techniques for fixing the graft in the conjunctiva vary according to the materials used that lead to different inflammatory responses, signs and symptoms influencing the patient’s satisfaction in the postoperative period. Studies evaluate the best material capable of reducing the inflammatory-exudative process, optimizing healing of the surgical procedure, and facilitating both the surgeon’s work and patient’s recovery(5)
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