Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery

Romano, Vito; Cruciani, Mario; Conti, Luigi; Fontana, Luigi

doi:10.1002/14651858.cd011308

Cited by 28 publications

(42 citation statements)

References 45 publications

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“…The use of fibrin glue used for attaching the conjunctival autograft in pterygium surgery not only reduces surgical time but also decreases conjunctival hyperemia, and ocular discomfort as compared with nylon 10/0 or with vicryl sutures; this proved conjunctival autografting is an excellent option for attachment of graft in pterygium surgery. [10] Ronamo et al [15] and Karalezli et al [16] also found that the use of fibrin glue in pterygium surgery with conjunctival autografting reduces surgery time, improves postoperative patient comfort, and results in a lower recurrence rate compared with suturing. Fibrin glue, however, is costly and many people from our place may not afford it.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of pterygium and outcome of pterygium surgery in hilly western Nepal

Manandhar¹,

Kc²,

Gurung³

et al. 2017

J Lumbini Med Coll

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Introduction: Surgical removal is the treatment of choice for pterygium; however, prevention of recurrence is a challenge. Several techniques have been tried to reduce the ﬁbro-vascular activity aiming to reduce rate of recurrence such as B-irradiation, conjunctival and limbal auto-grafting, anti-mitotic drugs, and amniotic membrane transplantation. This study reports the magnitude of the disease in a hilly region of western Nepal and outcome of excision and conjunctival autografting for pterygium surgery. Methods: A prospective study was done from 1st July 2015 to 31st December 2016 in which all patients with primary pterygium presented to Palpa Lions Lacoul Eye Hospital from 1st July 2015 to 30th June 2016 were treated and followed up for next six months. Patients were treated medically or surgically as indicated. Data on age, sex, visual acuity, extent of disease, treatment modality, complications, and outcome were collected and analyzed by descriptive statistics, Chi-square test, t-test, and Anova tests. P value less than 0.05 was considered significant. Results: There were 18,960 patients in total attending hospital for various conditions among which 290 (1.5%) had pterygium. There were 186 (64.1%) female and 104 (35.9%) male and this difference was significant (p<0.001). The mean age was 47.42 yrs (SD=14.23) with age ranging from 20 to 80 years. Right eye was affected more (43.1%) than left eye (33.1%); remaining 23.8% had bilateral disease. Grade-1 disease occurred in younger age compared to Grade-2 and Grade-3 disease. All grade-1 patients were managed medically; grade-2 and grade-3 patients were equally likely to be managed medically or surgically. There were no major intra or post-operative complications. Minor post-operative complications noted were subconjunctival hemorrhage, corneal scarring, suture gaping, and conjunctival cyst among others. Conclusion: Despite much advanced techniques in pterygium surgery, pterygium excision combined with conjunctival autograft is found to be a safe and effective method for treating pterygium in developing world.

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Section: Discussionmentioning

confidence: 99%

Prevalence of pterygium and outcome of pterygium surgery in hilly western Nepal

Manandhar¹,

Kc²,

Gurung³

et al. 2017

J Lumbini Med Coll

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“…Remover cirurgicamente o pterígio é tratamento de escolha, visto que, historicamente retirava-se somente a massa de tecido excessiva deixando uma ampla área de esclera nua (5) . No entanto, a recorrência da doença desafiava, e ainda desafia os oftalmologistas, uma vez que a excisão simples apresenta cerca de 30 a 70% de recorrência (2,6) .…”

Section: Abstract: Pterygium Fibrin Tissue Adhesive Suturesunclassified

“…Pensando nisso, duas estratégias foram adotadas, a primeira trata-se de abordagem destrutiva que potencializa o efeito da excisão cirúrgica com o uso de radiação e quimioterapia e a segunda abordagem é reconstrutiva, empregando inúmeros enxertos de tecido, entre eles enxerto autólogo de conjuntiva, transplante de membrana amniótica, entre outros (5) .…”

Section: Abstract: Pterygium Fibrin Tissue Adhesive Suturesunclassified

Adesivo tecidual de fibrina versus suturas para o enxerto autólogo de conjuntiva em cirurgias primária de pterígio: uma revisão integrativa / Fibrin tissue adhesive versus sutures for autologous conjunctiva graft in primary pterygium surgery: an integrative review

Mansur

Silva

Mansur

et al. 2020

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: Pterígio caracteriza-se pelo crescimento benigno fibrovascular, que surge da conjuntiva e se estende para a córnea. Atualmente a excisão cirúrgica, com enxerto autólogo de conjuntiva, constitui-se o tratamento padrão-ouro. No entanto, a sutura do enxerto é uma etapa demorada podendo induzir ao processo inflamatório local. Objetivo: Comparar os estudos sobre tratamento cirúrgico de pterígio confrontando a efetividade do adesivo tecidual de fibrina com as suturas no enxerto autólogo de conjuntiva. Método: Tratou-se de revisão integrativa utilizando-se da estrutura PICO para elaboração da pergunta norteadora. Os estudos foram levantados nas bases de dados: Cochrane Library, Medline via portal PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Eletronic Library Online) e Science direct. A ferramenta utilizada para indexação e recuperação de assuntos na literatura foi Descritor de Ciências da Saúde. Os critérios de inclusão foram: ensaios clínicos, randomizados, publicados entre 2015 a 2020 e disponíveis na íntegra. Resultados: Identificou-se duzentos e oitenta e um estudos, no entanto após a aplicação dos critérios de inclusão e exclusão restaram apenas cinco artigos. O tempo cirúrgico variou entre os tipos, sendo de 3,6 minutos a 20,17 ± 3,23 minutos para adesivo de fibrina e de 13,3 minutos a 32,42 ± 4,47 minutos para as suturas. Dentre os desconfortos oculares estavam sensação dolorosa e de corpo estranho, hiperemia conjuntival, hemorragia, edema e secreção. A recorrência foi observada em 19,9% dos voluntários dos estudos sendo 19,8% após o uso do adesivo de fibrina. Conclusão: Adesivo de fibrina mostrou-se seguro e eficaz para fixar enxerto autólogo de conjuntiva nas cirurgias de remoção de pterígio, mostrando-se capaz de reduzir o tempo operatório e as principais queixas dos pacientes no pós operatório imediato. No entanto, não oferece redução na taxa de recorrência, por isso deve-se atentar para risco aumentado de hemorragia conjuntival.Palavras chave: Pterígio, Adesivo tecidual de fibrina, Suturas ABSTRACT Introduction: Pterygium characterized by benign fibrovascular growth that arises from the conjunctiva and extends to a cornea. Currently, surgical excision with autologous conjunctival autograft is the gold standard treatment. However, suturing the graft takes a long time and induces a local inflammatory process. Objective: To compare studies on the surgical treatment of pterygium confronting the effectiveness of fibrin tissue adhesive with sutures in conjunctival autograft. Methodology: It was an integrative review using the PICO structure to elaborate the guiding question. The studies were surveyed in the databases: Cochrane Library, Medline via PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Electronic Library Online) and Science direct. The tool used for indexing and retrieving subjects in the literature was a Health Sciences Descriptor. The inclusion criteria were: clinical trials, randomized, published between 2015 and 2020 and available in full. Results: Two hundred and eighty-one studies were identified, however, after applying the inclusion and exclusion criteria, only five articles remained. The surgical time varied between types, ranging from 3.6 minutes to 20.17 ± 3.23 minutes for fibrin adhesive and 13.3 minutes to 32.42 ± 4.47 minutes for sutures. Among the eye discomforts were a painful sensation and a foreign body, conjunctival hyperemia, hemorrhage, edema and secretion. Recurrence was observed in 19.9% of the study volunteers, with 19.8% after the use of fibrin adhesive.Conclusion: The use of fibrin glue is safe and effective for fixing the autograft in pterygium removal surgeries, proving capable of reducing the operative time and the main complaints of patients in the immediate postoperative period. However, it does not offer a reduction in the recurrence rate and attention should be paid to the increased risk of conjunctival hemorrhage.Keywords: Pterygium, Fibrin tissue adhesive, Sutures

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“…In a recent Cochrane meta-analysis, Romano et al evaluated 14 randomized controlled trials (RCTs) and found that using the combination of fibrinogen and thrombin for CAG fixation resulted in lower recurrence rates (RR 0.47; 95% CI: 0.27-0.82; p = 0.0076) and quicker surgery (mean difference 17.01 min, 95% CI: −20.56 to −13.46; p < 0.001), as well as less postoperative discomfort than suturing [17]. Different types of fibrin glue behave similarly [18].…”

Section: Surgical Techniquementioning

confidence: 99%

“…However, fibrin glue may lead to more complications, including graft dehiscence, graft retraction, and granuloma compared with sutures (RR 1.92; 95% CI: 1.22-3.02; p = 0.0049) and it is more expensive than suturing [17,18]. It is speculated that decreased inflammation associated with the usage of glue may help to avoid recurrence [17,18].…”

Section: Surgical Techniquementioning

confidence: 99%