Sumeet Deshpande1, Rashmi R. Anwekar2
BACKGROUND
Pterygium removal is prone for recurrence. Use of conjunctival autografting is
considered the most suitable approach that can lower the recurrence.
Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing.
Recently fibrin glue has been used as an alternative to suturing. Advantages being
shortened operating time, improved postoperative comfort and absence of suture
related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which
has a fibrinogen component and a thrombin component prepared by processing
plasma. On activation of human fibrinogen by thrombin it imitates the final stage
of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable,
relatively easy to use and can be kept at room temperature or in a refrigerator.
We wanted to compare the postoperative outcomes in patients undergoing
pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue
group) in comparison to suturing with 10 - 0 nylon (suture group).
METHODS
This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the
Department of Ophthalmology. Patients with pterygium were enrolled into the
study after taking informed and written consent. Clinical grading of pterygium was
done as Grade 1 - < 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea,
Grade 3 - > 4 mm onto the cornea. 100 subjects were randomly divided into 2
groups of 50 patients each undergoing pterygium surgery between Nov 2018 and
Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2:
Conjunctival autograft with fibrin glue. A post-operative comfort scale was used
to assess pain, foreign body sensation and lacrimation. These patients were
followed up on postoperative day 1, one week, 1 month for postoperative signs
and symptoms and 6 months for any recurrence of pterygium.
RESULTS
Patients in the fibrin glue group experienced significantly less pain, foreign body
sensation and lacrimation on day-one, 1 week and at 1 month after surgery,
compared to those in the suture group. Other complications like graft oedema,
graft retraction, corneal scarring, sub graft haemorrhage were noted in both the
groups. At the end of 6 months follow up, no recurrence was noticed in both the
groups.
CONCLUSIONS
The use of fibrin glue for attaching autografts in pterygium surgery is an effective
method with global autograft success, less post-operative discomfort like pain,
foreign body sensation, lacrimation and less chance of recurrence.
