Recurrence Rate and Graft Stability With Fibrin Glue Compared With Suture and Autologous Blood Coagulum for Conjunctival Autograft Adherence in Pterygium Surgery: A Meta-Analysis

Maiti, Rituparna; Mukherjee, Somnath; Hota, Debasish

doi:10.1097/ico.0000000000001270

Cited by 17 publications

(14 citation statements)

References 41 publications

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“…It has been suggested that immediate adherence of the graft may inhibit fibroblast ingrowth and reduce recurrence. 33 Based on our study, we found that mild graft retraction and dehiscence, such as GS of grade 1 or 2, do not affect recurrence but are essential for wound healing. However, serious dehiscence (grade 3) and even dislocation (grade 4) may directly lead to recurrence, which necessitates repeated surgery to attach the graft as soon as possible.…”

Section: Discussionmentioning

confidence: 62%

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

Huang

Zhong

et al. 2020

Cornea

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Purpose: Surgical excision is the standard treatment for pterygium. This study was conducted to evaluate the safety and efficacy of a novel technique using low-temperature plasma (LTP) for excision and hemostasis in pterygium surgery. Methods: A prospective, comparative, and randomized clinical trial was conducted on 60 patients (60 eyes) undergoing pterygium excision with conjunctival autografts using fibrin glue. Patients were equally divided into the following 2 groups: a control group and a LTP group. Postoperative follow-up visits were scheduled on day 1, week 1, and months 1 and 3, and recurrence was evaluated at 1 year. Patients were examined for operative time, best corrected visual acuity, conjunctival autograft inflammation (CAI), graft stability (GS), pain, recurrence, and final appearance. Factors related to pterygium recurrence and final appearance were analyzed. Results: Mean operative times were shorter in the LTP group (16.7 ± 3.4 min) than those in the control group (20.1 ± 4.7 min, P = 0.002). LTP eyes had milder CAI than control eyes at postoperative day 1 ( P = 0.000) and week 1 ( P = 0.000). Patients in the LTP group exhibited better GS ( P = 0.01) and milder pain ( P = 0.04) than those in the control group on day 1. Two control patients (6.7%) and no (0%) LTP patients experienced recurrence ( P = 0.08). GS and CAI were the significant factors contributing to recurrence (GS: R = 0.425, P = 0.001; CAI: R = 0.309, P = 0.016). Conclusions: LTP to replace surgical blades and disposable cautery for ablation and hemostasis is safe and efficient for pterygium surgery, resulting in shorter operative time, milder inflammation, and better graft stability without increasing complication risk.

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Section: Discussionmentioning

confidence: 62%

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

Huang

Zhong

et al. 2020

Cornea

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“…However, this technique also presents drawbacks: intraoperatively takes more time, and postoperatively presents a high rate of graft loss. Maiti et al 14 showed no significant difference in the pterygium recurrence rate between conjunctival autograft fixation with fibrin glue vs. autologous blood coagulum, but graft stability was found to be better with the former.…”

Section: Discussionmentioning

confidence: 98%

Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization

Costa

Barbosa

et al. 2020

European Journal of Ophthalmology

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Purpose: To report a case series of pterygium surgery with conjunctival autograft fixation using bipolar electrocautery. Design: A noncomparative, retrospective, interventional case series of pterygium surgery with follow-up longer than 12 months to assess recurrence and other complication rates. Participants: Fifty-six eyes of 37 patients were treated between April 2011 and January 2018, either for primary ( n = 53 cases) or recurrent ( n = 3 cases) pterygia. Intervention: After pterygium excision, free conjunctival grafts from the inferior bulbar conjunctiva of the same eye were harvested and fixated with the use of bipolar electrocautery. Main outcome measure: Recurrence of the pterygium and complications. Results: The mean follow-up was 41 months (range 12 to 81 months). There were no intraoperative complications. Recurrence of the lesion was seen in three eyes (5.36%). There were no other postoperative complications such as graft detachment, or formation of dellen or granulomas. Conclusion: Conjunctival autograft fixation using bipolar electrocautery seems to be a fast, costly and safe procedure that can be applied in most cases of pterygium surgery.

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“…Além disso, inúmeros pacientes relataram ausência das complicações relacionadas com suturas, como sensação de corpo estranho (13) . Porém, vale ressaltar, que alguns estudos alertam sobre resultados conflitantes com estabilidade e recorrência da doença após o uso desse material (14) .…”

Section: Discussionunclassified

“…Os resultados apresentados corroboram com, Maiti et al (14) ao apontar que apesar do número reduzido de casos de recorrência entre os pacientes, que foi utilizado o adesivo de fibrina, não houve diferença estatística significativa entre os grupos.…”

Section: Autorunclassified

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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Recurrence Rate and Graft Stability With Fibrin Glue Compared With Suture and Autologous Blood Coagulum for Conjunctival Autograft Adherence in Pterygium Surgery: A Meta-Analysis

Cited by 17 publications

References 41 publications

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization

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

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