Fibrin Glue In Pterygium Surgery Research Articles

Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan

Introduction: Pterygium is a degenerative condition of the conjunctiva characterized by fibro vascular growth of tissue onto the cornea, often necessitating surgical treatment. Currently the conjunctival autograft technique using either suture or fibrin glue is the preferred method of treatment. The aim of the study was to evaluate the outcome of Pterygium surgery using sutures and glue to fix the graft. Methods: This observational study was carried out at the tertiary eye hospital, involving fifty-one patients (51 eyes) with primary Pterygium who underwent Pterygium surgery using either suture (19 eyes) or fibrin glue(32 eyes). The outcome measures were operative time, post-operative symptoms (pain, photophobia, foreign body sensation), and graft complications (displaced, edema, hemorrhage). Patients were followed up on day1, day 7, and day 28 after the surgery as per the standard protocol. Results: The study consisted of 17 males and 34 females, with mean ages of 51.95 (SD 9.82) in the suture group and 51.75 (SD 5.77) in the fibrin glue group. In the suture group, mean operation time was 14.16 (SD 2.71) minutes, and in the fibrin glue group, it was 13.72 (SD 4.54) minutes. With regard to the post- operative symptoms, the intensity of foreign body sensation was found to be higher in the suture group on day 1 and day 7 (p<0.003 and p<0.001, respectively). However the foreign body sensation was not observed in both groups on day 28. There was no significant difference in symptoms like Pain and photophobia. Notably, no graft complications were observed in either group on day 28. All patients completed the required follow ups. Conclusions: The use of fibrin glue in Pterygium surgery with conjunctival autografts relatively reduces surgery time and decreases early post-operative foreign body sensation thus improving early post-operative patient comfort compared to sutures.

The use of fibrin glue in pterygium surgery with amniotic membrane transplantation: Systematic review and meta-analysis.

To compare the outcomes of fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. An electronic search identified all studies comparing the outcomes of using fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation. Conjunctival inflammation, postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time were primary outcome measures. Secondary outcome measures included amniotic membrane transplant outcomes, time to recurrence, graft loss, and subconjunctival hemorrhage. Fixed and random-effects models were used for the analysis. Four studies enrolling 180 patients were identified. Conjunctival inflammation (odds ratio [OR] 0.21, P = 0.0005) demonstrated a significant difference favoring the fibrin glue group. Despite the trend favoring the use of fibrin glue, there were no significant differences in terms of postoperative pain and discomfort (OR = 0.46, P = 0.25), pterygium recurrence (OR = 0.74, P = 0.48), pyogenic granuloma (OR = 0.47, P = 0.38), and surgical time (mean difference = -17.52, P = 0.13). For secondary outcomes, fibrin glue had significantly fewer cases of graft loss compared with sutures. No statistically significant difference was found in amniotic membrane graft outcomes, time to recurrence, and subconjunctival hemorrhage. Fibrin glue is comparable to the sutures used in pterygium surgery with amniotic membrane transplantation as it significantly improves conjunctival inflammation and does not increase postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time.

Fibrin glue versus suture technique for pterygium excision: A prospective study in tertiary-based rural hospital

Aim: The aim of this study is to compare the results of conjunctival closure in pterygium surgery using fibrin adhesive versus vicryl sutures. Materials and Methods: This study was carried out in the premises of rural-based tertiary hospital. A comparative prospective study was performed in fifty patients (fifty eyes) with primary nasal pterygium. They were randomized to undergo pterygium surgery using either 8-0 vicryl sutures (25 eyes) or fibrin glue (25 eyes) to attach the conjunctival autograft from August 2014 to February 2015. Mean follow-up was 14 months. Outcome measures were duration of surgery, complication, postoperative discomfort, and recurrence of pterygium. Clinical assessment was performed on days at 1, 7, and 14 days, and every 2 months thereafter. Statistical Analysis: All data were evaluated by using SPSS version 19.0 (Released 2010, IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.) package program. Mann-Whitney U-test was used for the comparison of symptoms and signs of two groups. Unpaired t-test was used to compare two groups in terms of surgery time as well as recurrence rates. Results: Average operative time was 15.76 min (range 12-20 min) in the fibrin glue and 33.56 min (range 30-45 min) in the suture group (P < 0.001). The symptoms such as pain, photophobia, foreign body sensation, watering and conjunctival, and chemosis were significantly less in the subjects treated with glue than suture (for chemosis and photophobia [P = 0.001]; for pain and watering [P < 0.001]). Three cases of recurrence in the suture group and one case of pyogenic granuloma in the fibrin glue group were reported. Conclusion: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort.

Complications of fibrin glue in pterygium surgery with amniotic membrane transplant.

To compare the complications and the recurrence rate between fibrin glue (TISSEEL) and Vicryl 8-0 sutures in amniotic membrane transplant during pterygium surgery. Patients who underwent pterygium surgery with amniotic membrane transplant (AMT) in the Wang Eye Clinic (Doraville, USA) were randomly categorized into two groups: one group received TISSEEL and the other group received Vicryl 8-0 sutures. All procedures for both groups were performed by one ophthalmologist. Twenty-four patients (24 eyes) participated in the TISSEEL group (22 eyes with primary surgery and 2 eyes with surgery for recurrence) and 19 patients (19 eyes) took part in the suture group (18 primary eyes and 1 recurrence). The patients with recurrent pterygium in both groups had not received AMT previously. Post-operatively, patients were followed up for one week and then one year to check for any signs of complications and recurrence. Conjunctival inflammation occurred in 3 eyes (12.5%) in the TISSEEL group, and 6 eyes (31.6%) in the suture group (P<0.05, Chi-square test). In the TISSEEL group, 1 eye (4.2%) showed recurrence, while there were no recurrences in the sutures group. There were 3 dry eyes (15.8%) in the suture group and 2 dry eyes (8.3%) in the TISSEEL group (P>0.05). No dislocated conjunctival grafts, Dellen, inflammation, infection, bleeding, pyogenic granuloma, or scleromalacia was observed in either group. Pterygium surgery with AMT had less conjunctival inflammation and dry eye in patients receiving fibrin glue than those with Vicryl 8-0 sutures.

Non-Recurrence Complications of Fibrin Glue Use in Pterygium Surgery: Prevention and Management.

Purpose :To present complications of using fibrin glue in conjunctival-limbal autografting in pterygium surgeries other than recurrences and discuss their prevention and management strategies.Materials and Methodology:The charts of all patients who underwent fibrin glue assisted pterygium excision surgery with conjunctival-limbal autograft transplantation from 2010 to 2013 were reviewed. Patients who developed complications except recurrence postoperatively were included in this study.Results :Sixteen (17.39%) of the 92 patients were detected with a complication. Graft dehiscence was diagnosed in 7 (7.6%) patients with 5 of them treated conservatively and 2 patients requiring suturing. Five (5.43%) patients were diagnosed with cyst formation between the graft and conjunctiva or in the graft-removal area; these cysts were primarily excised and no additional problems occurred. Corneal dellen developed in 3 (3.26%) patients and 2 of them regressed after cessation of topical steroids and application of lubricant therapy while one was treated with amniotic membrane transplantation. Residual fibrin glue particles had stiffened on the ocular surface, which resulted in intensive pain and irritation in one (1.08%) patient on the same day of the surgery. The patient’s complaints were reduced by removing these particles from the ocular surface under topical anesthesia.Conclusion :Complications in fibrin glue assisted pterygium surgery are relatively different from other techniques. To avoid potential complications of fibrin glue in pterygium surgery, peroperatively ophthalmologists should ensure the conjunctival autograft and conjunctiva are properly adhered, fibrin glue remnants are completely removed from the ocular surface, and no Tenon’s capsule remains between the graft and the conjunctiva.

The influence of pterygium morphology on fibrin glue conjunctival autografting pterygium surgery

To evaluate the influence of pterygium morphology on the efficacy and safety of fibrin glue in pterygium surgery with conjunctival autografting. A prospective case series. During a period of 15months, 45 patients (51 eyes) were recruited from the General Hospital for pterygium surgery. Seven eyes (13.73%) were operated on for a recurrent pterygium. Autologous conjunctiva was harvested from the superior bulbar conjunctiva and fixed with fibrin glue. The pterygia were preoperatively divided into atrophic/grade 1 (n=18; 35.29%), intermediate/grade 2 (n=22; 43.14%) or fleshy/grade 3 (n=11; 21.57%) according to clinical morphology. Patients were evaluated for intraoperative and postoperative complications and recurrence rates. The success rate was defined by no pterygium recurrences. Patients with 2-year follow-ups were included in this study. Fifty-one patients (21 females/30 males) with a mean age of 60-65years (range 24-87years) took part in the study. All patients completed the study. No intraoperative complications were noted. Postsurgical complications included graft edema (n=4; 7.8%), graft hyperemia (n=2; 3.8%), and graft dislocation (n=3; 5.9%); these complications were transient. One graft unfastened completely (2%) and five pterygium recurrences occurred (n=5; 9.8%). The overall success rate was 90% after 2years. In grade I group there were no recurrences, in grade 2 group there were two recurrences, and in grade 3 group there were three recurrences. There were significantly more recurrences in grade 3 group than in grade 2 group. There were more recurrences in both groups than in group 1 (60 vs 40 vs 0% of all recurrences, p≤0.05). The use of fibrin glue is a safe, easy and effective technique for attaching the conjunctival autograft in pterygium surgery. The morphology of pterygium influences recurrence rates, without significance for intraoperative and postoperative complications.

Safety and Efficacy of Fibrin Glue versus Vicryl Sutures in Recurrent Pterygium with Amniotic Membrane Grafting

Purpose: The study aimed to compare surgical outcomes with likely toxic side effects when using pterygium excision and amniotic membrane grafting with fibrin glue versus Vicryl sutures. Method: This is a prospective randomized study. Patients were classified into two groups: group 1 consisted of 20 patients with Vicryl-sutured grafts, and group 2 consisted of 20 patients with fibrin-glued grafts that were prepared from autologous blood. Results including surgery time, patient discomfort, complications and recurrence rates within 1, 6 and 12 months were analyzed. Results: The study demonstrated that there was a statistically significant decrease in surgery time in the fibrin glue group (the procedure took 17 min) relative to the sutured group (28 min; p < 0.05). Additionally, both postoperative pain and discomfort were noted significantly less often in the fibrin glue group. Complications were also decreased in the fibrin glue group. Conclusion: The study revealed that the use of fibrin glue in pterygium surgery with amniotic membrane grafting was safer, less toxic and less time-consuming, and resulted in fewer complications than graft surgery with sutures.

Comparison of Fibrin Glue versus Suture for Conjunctival Autografting in Pterygium Surgery: A Meta-Analysis

To evaluate the safety and clinical efficacy of fibrin glue in pterygium surgery with conjunctival autografting. The use of fibrin glue has been introduced in the treatment of pterygium. However, its role versus traditional suturing is still a matter of debate. We performed a meta-analysis to compare the safety and clinical efficacy of fibrin glue with suture for conjunctival autograft attachment in pterygium surgery. A total of 342 participants with 366 eyes in 7 studies were analyzed. We searched Medline, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs). The methodological quality of all the included trials was assessed with the Jadad score. The meta-analysis was performed with the fixed-effects model for complication rate and recurrence rate, and random-effects model for operating time. Fibrin glue was associated with a significantly decreased operating time (weighted mean difference -17.61 minutes, 95% confidence interval [CI], -26.03 to -9.18, P<0.0001) and was more effective in reducing the recurrence rate (Peto odds ratio [OR] 0.33, 95% CI, 0.15-0.71, P = 0.004) compared with suture. There were no significant differences in the complication rate (Peto OR 1.82, 95% CI, 0.63-5.27, P = 0.27) between the 2 groups. Our meta-analysis supports the superiority of fibrin glue to suture in pterygium surgery with conjunctival autografting in that the use of fibrin glue can significantly reduce the recurrence rate without increasing the risk of complications. Ophthalmologists should consider the use of fibrin glue in pterygium surgery. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Assessment of Fibrin Glue in Pterygium Surgery

To evaluate the efficacy and safety of fibrin glue in pterygium surgery with conjunctival autografting. This was a prospective noncomparative case series. Patients were recruited from the general clinics for pterygium surgery. For pterygium surgery, autologous conjunctiva was harvested from the superior bulbar conjunctiva after pterygium excision. The graft was secured to bare sclera at the site of the pterygium by Tisseel fibrin adhesive. Patients were followed up with a standard form. Key parameters included visual acuity, graft integrity, and graft size. The rate of pterygium recurrence was monitored. A total of 24 patients were recruited, and 29 pterygia were excised with conjunctival grafting. All conjunctival grafts were secured adequately with no cases of dislodgement. Graft dimensions tended to decrease slightly in the early postoperative period, followed by stabilization. There were no cases of serious adverse events and no reduction in visual acuity. One pterygium recurrence occurred at 3 months. One spontaneous subgraft hemorrhage occurred with no effect on graft stability. Tisseel fibrin glue provided adequate adhesion of conjunctival grafts to the ocular surface. Healing was characterized by a comfortable eye, minimal inflammation, and good cosmetic result. There were no significant complications and the results appeared similar to those reported in the literature for sutured grafts.

Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts

To compare pterygium excision conjunctival autograft surgery using Tisseel fibrin glue versus Vicryl sutures. Prospective randomized clinical trial. Fifty patients were randomized into either sutured graft or glued graft groups. Twenty-five received standard conjunctival autograft sutured with Vicryl and 25 received surgery with the autograft placed with Tisseel fibrin glue. Outcome measures include surgical time, patient discomfort, pathology, complications and recurrence rates at 3, 6 and 12 months. Patients were followed up at days 1, 7, 14, 30, 90, 180 and 365. The mean surgical time for the glue group was significantly shorter at 12 min compared with the suture group at 26 min (P < 0.001). Postoperative pain was significantly less at day 1 (P < 0.001) and day 2 (P < 0.05) but was not significantly different following these visits. Complications in the glue group included one patient with an absent graft at week 1 that required revision of the graft. At 3 months there were no recurrences in the glue group and two recurrences in the suture group. The 6- and 12-month recurrence rate was unchanged and not significantly different between the glue and suture groups (both 0/24 and 2/23, respectively). Both glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. The glued autograft recurrence rate at 12 months was similar to that of sutured grafts. Conjunctival autograft with fibrin glue in pterygium surgery decreased surgical time and resulted in less postoperative pain in the first 48 hours but had a higher complication rate.

Amniotic membrane transplantation using fibrin glue in pterygium surgery: a comparative randomised clinical trial

To compare the results of amniotic membrane transplantation (AMT) using fibrin glue vs vicryl sutures in pterygium surgery. We carried out a prospective, randomised clinical study of 70 eyes (70 patients) with primary pterygium. After the removal of pterygium, patients were randomised to undergo AMT using fibrin glue (Tisseel, 32 eyes) or 8-0 vicryl sutures (38 eyes). Clinical examination and digital photographing were performed at each visit and the patients were followed up for at least 12 months. Post-operative symptoms in the first month were evaluated according to a five-point scale. Final appearances were graded from 1 to 4 in which grade 4 represented true (corneal) recurrence and grade 3 indicated conjunctival recurrence. The average operation time in the fibrin glue and suture groups were 11.2+/-2.4 min (mean+/-SD) and 18.7+/-2.2 min, respectively (P=0.018). Significantly fewer post-operative symptoms were observed in the fibrin glue group at post-operative days 1, 7, and 14 (P<0.05 for all). At the end of the follow-up, true recurrence (grade 4) was developed in three eyes (9.4%) in the fibrin glue group, and in four eyes (10.5%) in the suture group (P=0.33). The rates of conjunctival recurrence (grade 3) were 21.9% (seven eyes) and 23.7% (nine eyes) in the fibrin glue and suture groups, respectively (P=0.38). Amniotic membrane grafts can be successfully attached without any major complication in patients undergoing pterygium surgery. In addition, it is effective in shortening the duration of surgery and preventing post-operative discomfort. Although there seems to be no difference in the recurrence rates and cosmetic outcomes between both groups, neither technique represents best results.

Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular

To compare recurrence rate, complications, and biomicroscopical findings after conjunctival autograft pterygium surgery with the use of a fibrin glue (Tissucol Duo, Baxter AG, Vienna, Austria) or suture (7-0 silk). Patients with nasal pterygium were included in two groups of conjunctival autograft surgery. In 9 of them the graft was sutured to the surrounding conjunctiva and in 8 of them the graft was fixed to the conjunctiva using fibrin glue. 17 patients (17 eyes) 41.2% women and 58.8% men were surgically treated. Mean patient age was 59.8 years. Five of the patients presented recurrence for simple excision and 12 presented primary pterygium. The extent of corneal invasion was 2 to 4 mm. In the suture group, 33.3% of the patients experienced pain after surgery compared to none in the fibrin glue group. In the suture group, 44.4% of the patients presented inflammation after surgery compared to none in the glue group. One patient from the glue group lost the graft and presented a recurrence one month later. The use of fibrin glue in pterygium surgery reduces patient symptoms, inflammation and discomfort. The rate of recurrence seems to be similar in both procedures.

Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study

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...

Fibrin Glue versus Vicryl Sutures for Primary Conjunctival Closure in Pterygium Surgery: Long-Term Results

Purpose: To compare the long-term results of conjunctival closure with fibrin adhesive or Vicryl sutures in pterygium surgery. Methods: The study was performed in 81 patients (81 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative administration of mitomycin C 0.02%. Patients were randomized to undergo conjunctival closure with a fibrin adhesive (Quixil) (n = 42) or Vicryl sutures (n = 39). Clinical assessment was performed on postoperative days 1, 3, 10, and 21 and thereafter at 3, 6, and 12 months. All patients completed a questionnaire at each follow-up visit grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, overall satisfaction, and recurrence rate. Results: Average operative time was 16 min in the fibrin-glue group and 28 minutes in the Vicryl-suture group (p < 0.05). Significantly less pain and discomfort were noted in the subjects treated with glue than in controls (p < 0.05). Satisfaction was significantly higher in the study group (p < 0.04). There were no complications during follow-up period in the glue-treated patients; one patient in the suture group had a medically treatable corneal dellen. At the end of follow-up, recurrent pterygium developed in five (11.9%) eyes of the fibrin-glue group and in three (7.7%) eyes of the Vicryl-suture group (p < 0.05). Conclusions: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient pain compared with suturing. However, it may be associated with a higher recurrence rate.

Pterygium Surgery

To compare the short-term results of conjunctival closure in pterygium surgery using fibrin adhesive versus Vicryl sutures with respect to operative time, postoperative ocular signs and symptoms, and overall patient satisfaction. A comparative prospective randomized clinical trial was performed in 65 patients (65 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative mitomycin C. Patients were randomized to undergo conjunctival closure with a fibrin tissue adhesive (Quixil; n = 39) or 8-0 Vicryl absorbable interrupted sutures (n = 26). Clinical assessment was performed on days 1, 3, 10, and 21 after surgery. Patients completed a questionnaire at each follow-up visit, grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, and overall satisfaction. Average operative time was 16 minutes (range, 14-16 minutes) in the fibrin glue group and 20 minutes (range, 20-29 minutes) in the Vicryl suture group (P < 0.05). Significantly less pain, photophobia, foreign body sensation, irritation, epiphora, itching, local hyperemia, conjunctival chemosis, and dry eye were noted in the subjects treated with glue than in controls (P < 0.05). There were no complications during the 3-week follow-up period in the glue-treated patients. One of the patients in the suture group had a medically treatable corneal delle. The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort. A longer follow-up is needed to evaluate the influence of fibrin glue on rate of recurrence and long-term complications.