Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial (original) (raw)
Related papers
International Journal of Health Sciences and Research, 2014
Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing primary pterygium excision. Methods: This was a prospective comparative clinical study. A total of 80 patients (80 eyes) with primary nasal pterygium were randomized to undergo pterygium excision and conjunctival autografting using either fibrin glue (40 eyes) or 10-0 nylon suture (40 eyes). Patients were followed up for 6 months. The groups were compared in terms of duration of surgery, degree of postoperative discomfort, inflammation, subconjunctival haemorrhage, graft stability and pterygium recurrence. Results: The mean surgery time in fibrin glue group was 14.5 minutes and in suture group was 26 minutes (p=0.000). Fibrin glue group had significantly lesser postoperative discomfort (p=0.000) and inflammation (p=0.001) compared to suture group at post-op day 1 and week 1, with no difference at subsequent follow-ups. No significant difference was found in degree of sub...
IP innovative publication pvt ltd , 2020
Introduction: Pterygium is a slow growing, wing shaped, elastoticsubconjunctival degeneration within the palpebral fissure involving the cornea. As it encroaches the limbus, it proliferates as vascularised granulation tissue destroying the superficial stroma and Bowman’s membrane and is characterized by tissue remodelling, cellular proliferation, neovascularisation and inflammation. Objective: To compare between fibrin glue and polyglactin sutures in limbal based conjunctival autograft technique in primary pterygium surgery in terms of duration of surgery and early and late post-operative complications. Materials and Methods: It was a prospective comparative, randomized controlled trial which was conducted at North Bengal Medical College, Darjeeling, from July 2016 to June 2017. Patients with progressive pterygium diagnosed after proper clinical examinations and admitted for excision with conjunctival autograft attached with fibrin glue or for excision with conjunctival autograft sutured with 8-0 polyglactin. Data were collected and analysed. Results: 52 patients were randomly and equally divided into two groups, group A (fibrin glue) and group B (sutured with polyglactin) according to the type of surgery. In both the groups, there was female preponderance and the average age of the patients were 45.15 (5.576) and 40.65 (8.299) years respectively. Regarding the post-operative complications such as graft oedema (p= 0.002, c2 =10.035, df = 1), graft granuloma (p =.037, c2 = 4.333, df = 1) and recurrence (p = 0.638, c2 = 0.221, df = 1), the group A had less incidence than group B. The reduction of complications was statistically significant in group A in terms of graft oedema and graft granuloma but not in recurrence.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Pterygium is excessive sub-conjunctival proliferation of fibrovascular tissue or elastotic degeneration of tissue under the epithelium. Pterygium is seen nearly twice as often in men as in women. Ophthalmologists had a real challenge for successful management pterygium due to its high recurrence rate (2.1% to 87%). Pterygium is a local limbal cell deficiency. Pterygium recurrence can be reduced if the limbus and limited area of cornea are included in the conjunctival graft, as it is well recognized that limbal stem cells play a vital role in maintaining the ocular surface. The objective of the study is to evaluate effectiveness and outcome of two surgical procedures for conjunctival autograft fixation-with autologous blood vs. polyglactin suture. To evaluate the outcome of the two surgical technique in terms of surgical time, post-operative pain and discomfort, graft related complication, uptake of graft, recurrence. MATERIALS AND METHODS This was a prospective, comparative interventional, case series of 60 eyes over a period of three years. These 60 patients were divided into two group. In this study, in 30 eyes of the patients, pterygium excision with conjunctival autograft was secured with 8-0 polyglactin sutures and were allocated to group A. The remaining 30 eyes of the patients who underwent pterygium excision with conjunctival autograft were secured with auto blood and they were allocated to group-B. RESULTS In this study, mean age of the patient in group-A is 44.7 ± 8.2 and in group-B 47.8 ± 8.8. Sex distribution in Gr-A-50% were male and 50% were female. In Gr-A 67.7% were male and 37.7% female. Side of involvement-in gr-A right side involvement 76.7% and left side was 23.3%. Length of pterygium encroaching over cornea in mm (mean) S.D. 3.0 ± 0.40 in Gr-A (mean) S.D. 2.95 ± 0.59 in Gr-B. Vessel pattern in Gr-A. Thin vessel 33.3%, Tortuous vessels 30%, Vascular band 36.7%. In Gr-B thin vessel 43.7% Tortuous vessels 30.5%, Vascular band 26.3%. Operation time in Gr-A 37.3 ± 8.2 min and in Gr-B 17.5 ± 2.3 min. Average time difference was 19.8 min. Regarding graft fixation time-in Group A graft fixation time was fixed for 24 hours. In Group B graft fixation time was gradually decreased from 48 hours to 20 hours. In Graft related complication 20% in Gr-A 13.3% in Gr-B. In terms of recurrence 16.7% in Gr-A and 6.7% in Gr-B and p value P<0.67 which was clinically significant. Relation in between recurrence & vessel pattern (vascular band). The risk of recurrence significantly increases when there in presence of vascular bands. The estimated risk is 1.5 with a 95% CI. CONCLUSION Conjunctival auto blood auto graft is superior to suturing procedure. It is a less invasive surgery than in suturing group. It has less post-operative inflammation. It has less graft related complications at the end of 6 months. It has less chance of recurrence on following up for a period of 6 months. It has early rehabilitation time. It is cost effective. It has good cosmetic effect because it has smooth operative surface area and has good cosmetic and functional outcome.
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND Pterygium is a very common cause of visual disturbance and is treatable surgically. It is treatable by conjunctival autograft. The autograft can be sutured or can be fixed with glue or autoserum. In this study, we have compared the procedure of suturing of conjunctival autograft and sutureless autoserum procedure after the excision of pterygium. MATERIALS AND METHODS We have studied 100 patients of primary pterygium attending the outpatient department of tertiary care centre for treatment of primary pterygium, during the period from November 2015 to October 2017 with the approval of ethical committee of Katuri Medical College, Guntur. We have allocated these patients in to two groups. Group I patients numbering 50 underwent pterygium excision with limbal conjunctival autograft and the auto graft was secured with autologous serum. Group 2 patients numbering 50 had conjunctival autograft secured by sutures. Patients were examined on the first postoperative day and at the end of 1st week, 6th week and 12th week post operatively. RESULTS Eighty percent of the patients in both groups were in the age group of 31 to 60. 78% of patients of pterygium are females. Nearly half of the patients had Grade T2 Pterygium. Most of the patients in both the groups had wide based pterygia. The mean duration of surgery in Group 2 (28.34 minutes) was found to be longer than that of Group 1 (18.68 minutes), Pain and foreign body sensation were lesser throughout the follow-up period and disappeared more rapidly in Group 1 compared to Group 2, and the difference was found to be statistically significant (p<0.001). There was no difference in graft oedema between the two groups (p>0.05). There was no evidence of recurrence in both the groups, during the period of follow-up. CONCLUSION Both conjunctival autografting with autologous serum and with sutures are safe with low recurrence but autografting group has lesser symptoms and duration of surgery is shorter with autologous serum group. Graft displacement and graft retraction were equal in both the groups
A Clinical Study of Conjunctival Autograft Using Fibrin Glue in Primary Pterygium Surgery
Back ground: Pterygium is a common external Ocular disease in tropical countries like India. Excision of the pterygium is the only modality of the treatment for pterygium. Recurrence of pterygium is the most common complication following excision with the bare sclera technique. This was minimized by using autoconjunctival graft with sutures in primary pterygium surgery, but this is associated with sutures related complications. Fibrin glue is used to minimize the suture related complication in auto conjunctival graft surgery. AIM: To evaluate the safety and efficacy of conjunctivalautograft using fibrin glue, which minimize the suture induced complications Material & methods: It is a prospective study conducted in Ophthalmology dept. S.V. medical college Tirupati. 50 eyes of 50 patients with progressive pterygium were included in the study. Pterygium excision surgery with autoconjunctival graft using fibrin glue was done.The conjunctiva taken from the supero temporal quadrant of the same eye. Patients were followed for 6months to evaluate post operative complications and recurrence of pterygium. Results: Of the 50 patients incidence was similar in both sexes. Majority of the patients [60% ] belonged to the age group of between 30-50 years. Major post operative complications observed in this study were graft oedema (16%) and haemorrhage[ 8%] of the patients. The follow up period was uneventful with minimum complications. No recurrence of pterygium was seen during follow up period. Conclusion: The case series suggests that fibrin glue is a safe and useful alternative method for graft fixation in primary pterygium surgery
International ophthalmology, 2017
To compare the safety, operating time, postoperative ocular signs, symptoms, overall patient satisfaction, complications rate and recurrence rate of autologous fibrin glue (AFG) and nylon suturing (NS) for attaching conjunctival autografts in pterygium surgery. A prospective, randomized, interventional study was performed among 120 patients (120 eyes) with primary pterygium. Superior conjunctival autograft was harvested and transferred on to bare sclera after pterygium excision. For attaching the autograft, AFG (n = 60 eyes) and NS (n = 60 eyes) were used. The patients were followed up for 12 months. The groups were compared for the safety, operative time, postoperative ocular signs, symptoms, overall patient satisfaction, recurrence and complications rate. All conjunctival autografts in both groups were successfully attached. The average operating time for the AFG group was significantly shorter (P < 0.001). Postoperative symptoms were fewer for the AFG group than the suture gro...
IP innovative publication pvt. ltd, 2019
Introduction: A pterygium is a triangular 'wing-like' growth consisting of conjunctival epithelium and hypertrophied subconjunctival connective tissue that occurs nasally and/or temporally in the palpebral fissure and encroaching over to the limbus and then to the cornea. Actual pathogenic mechanisms of this condition is unknown hence remains an enigma in ophthalmlogy. This degenerative thick and vascular conjunctival and sub-conjunctival tissue is triangular in shape and most commonly found on the nasal side and also it progressively destroys the corneal bowman's layer and superficial layer of the stroma. It is most commonly seen in the tropical country, implicating sunlight and UV radiation as a probable cause. Objective: To compare the post-operative outcome of primary pterygium excision followed by autologous limbal conjunctival grafting with application of sutures vs suture-less and glue-less. Materials and Methods: This study is a prospective comparative and interventional case study. 50 eyes with primary pterygium are selected. Patients were divided into two equal groups with 25 number of eyes in each group. a) Group-I = suturing of auto graft with (10-0) nylon sutures b) Group-II = fixing of auto graft without sutures i.e. Suture-less and without glue i.e. glue-less. Results: The average operative time for Group-I was 26.44 ± 8.19 min and for Group-II was 20.52 ± 5.13 min (p-value < 0.05). Postoperative symptoms were seen in Group-I in 18 eyes i.e.72% and in Group-II in 4 eyes i.e. 16% (p-value <0.05). The severity of symptoms i.e. postoperative discomfort was observed more in Group-I than Group-II from 1 st Postoperative day. The duration of which lasted in Group-I for < 3 weeks for and Group-II for < 1 week (p-value < 0.05). The patients belonging to Group-II were symptom free than the Group-I from the first postoperative day onwards. Post operatively in Group-1 Graft oedema was seen in 5 eyes i.e.20% and in Group-II= 3 eyes i.e.12% which resolved within ≤ 2week. In Group-I = 2 patients i.e. 8% had graft lost and 1-patient i.e. 4% had recurrence which is statistically insignificant. Conclusion: Lots of surgical procedures has been tried for the treatment of primary pterygium this technique of fixing the auto-graft without sutures i.e. suture-less and without glue i.e. glue-less is rather an evolving one getting preference by the modern surgeons worldwide as it is less time consuming, more convenient in the sense of avoiding complication of sutures and glues thereafter the related problems of the sutures and glues, moreover it's cost effectiveness is an advantage.
Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts
Journal of Ophthalmic and Vision Research, 2020
Purpose: To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery. Methods: We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm2) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence. Results: The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The s...
Purpose:To evaluate and analyse the surgical technique and post-operative surgical outcome,surgical time, recurrence and complication in a clinical and histopathological study of superior versus inferior conjunctival autograft using fibrin glue in the management of primary Pterygium. Methods: This was Prospective Mean size of CAU(mm²) in groupA (26.88±1.2) GroupB (26.86±1.2) by student t test p value is 0.93Mean surgical time is almost similar in Both Group A(17.36±1.8min) range (13-22 min) & group B (17.48±1.7min) range (13-21 min) by student t test p value is 0.21 Recurrence occure in 2% case of conjunctival autograft by using Fibrin glue in both group A & group B conclusion: Inferior auto-graft with fibrin glue has the same advantages as superior one as regard rate of recurrence and surgical time but superior to it as regard patient discomfort and saving superior conjunctiva sparing it for future glaucoma surgery if needed. Use of fibrin glue for securing conjunctival autografts reduces recurrence rates significantly and is safe due to fewer postoperative complications.Superior conjunctiva is the most common site for harvesting donor autograft in pterygium surgery but sometimes it is difficult or not recommended to take the conjunctival autograft from the superior conjunctiva as in scarring of the superior conjunctiva due to previous surgery or trauma or post infection; patients who have had filtration surgery; patients with glaucoma who may require future filtration surgery .In our study there was no statistically significant difference in the recurrence rates between the 2 groups.Perygium excision with superior or inferior CAU secured with fibrin glue is safe and effective. There was no significant difference in surgical time, pain, and recurrence rates of pterygium after excision with superior or inferior CAU.