J.Talajic, K. Miszkiewicz, L. Racine, M. Harissi-DagherThe authors have no financial interest in the subject matter of this poster.

Fibrin Glue versus Nylon Sutures for Conjunctival

Autograftingin Pterygium Surgery

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BACKGROUND

• Conjunctival autografting after pterygium excision is associated with very low rates of recurrence.

• Disadvantages of graft suturing include: longer surgery duration (vs. bare sclera technique), potential for granuloma formation and giant papillary conjunctivitis, and patient discomfort.

• Fibrin-based adhesives for the attachment of conjunctival grafts have been associated with shorter surgery duration, improved patient comfort, and fewer complications. However, the recurrence rates with the use of fibrin glue have been investigated in few studies, the results of which have been inconsistent.

PURPOSE

• To determine the safety and efficacy of using fibrin glue (Tisseel VH, Baxter) to attach conjunctival autografts

• To compare the results with the use of nylon sutures in patients undergoing primary pterygium excision

STUDY DESIGN

A retrospective case series was conducted of 23 eyes (23 patients) who underwent primary pterygium excision with conjunctival autograft between 2007 and 2009 at CHUM Hôpital Notre Dame in Montreal, Canada. Patients with autoimmune disease, a history of previous ocular surgery or trauma, and those who received intraoperative Mitomycin C were excluded from this study.

METHODS

Of the 23 eyes that had undergone pterygium surgery, 12 conjunctival autografts were attached using fibrin glue by residents under the observation of one surgeon, and another 12 autografts were sutured in place with 10-0 nylon sutures by a different attending surgeon. A chart review was conducted and patients were reexamined to evaluate differences in:• operating time

• graft success (graft intact 4 weeks postoperatively)

• pterygium recurrence (growth 1 mm onto cornea)

• postoperative patient comfort

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RESULTSSUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION

WITH CONJUNCTIVAL AUTOGRAFT

 FIBRIN GLUE

NYLON SUTURES

P Value

Age (years) 57.2 51.2 0.355

Sex (%Male) 73 50 0.400Ethnicity (% Caucasian)

45.5 75 0.214

Eye (% OD) 45.5 41.7 0.256Surgery duration (min per pterygium)

25.1 25.3 0.457

Mean F/U (months) 7.4 11.3 0.609Graft Success (%) 96 100 1.0Recurrence (%) 27.3 8.3 0.317

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FIBRIN GLUE GROUP

PatientAge

(years)

Sex EthnicityEye and location

Surgery duration

(min)

Mean F/U

(months)

FBS Postop Recurrenc

eGraft

Success

1 35 M African OS nasal 35 8.2 No No Yes2 39 M African OS nasal 20 5.6 PO day 1 No Yes3 45 M Hispanic OD nasal 35 1.4 No No Yes

4 45 M AsianOD nasal

& temporal

25 9PO month

1Yes (nasal

& temp)Temp: Yes Nasal: No.

5 49 M Caucasian OS nasal 38 10.4 PO day 1 Yes Yes

6 54 M BlackOD

temporal25 17.5 No No Yes

7 63 F Caucasian OS nasal 19 9.6 No No Yes8 71 M Caucasian OS nasal 36 6.1 No Yes Yes

9 73 F CaucasianOD

temporal21 5.2 No No Yes

10 76 M Hispanic OD nasal 25 3.5 PO day1 No Yes11 79 F Caucasian OS nasal 30 4.5 PO day 1 No Yes

NYLON SUTURE GROUP1 31 F Hispanic OS nasal 24 19.5 PO week 1 No Yes2 41 F Caucasian OS nasal 23 11.4 PO week 1 No Yes3 44 M Caucasian OD nasal 30 18.2 PO week 1 No Yes4 48 F Caucasian OD nasal 22 10 PO month 1 No Yes5 50 M Hispanic OS nasal 25 8.3 PO month 1 No Yes6 50 M Caucasian OD nasal 29 7.1 PO week 1 No Yes7 54 F Black OS nasal 28 17.2 PO week 1 No Yes8 57 F Caucasian OS nasal 20 6.7 PO week 1 Yes Yes9 60 M Caucasian OD nasal 25 7.6 PO week 1 No Yes

10 61 F Caucasian OS nasal 24 9.5 PO week 1 No Yes11 63 M Caucasian OD nasal 27 6 No No Yes12 65 M Caucasian OS nasal 30 14 PO week 1 No Yes

CONCLUSIONThis study suggests that fibrin glue attachment of conjunctival autografts in primary pterygium excision surgery is effective and safe. The fibrin group showed less discomfort and slightly shorter operating time (with residents operating the majority of time in this group) as compared with the standard nylon suturing technique. However, the fibrin group resulted in a higher rate of recurrence. None of these differences was statistically significant. A larger study with the same surgeon performing both surgical techniques may be beneficial in determining whether recurrence is more frequent with the use of fibrin glue.

REFERENCES

 1. Jiang J, Yang Y, Zhang M, et al. Comparison of fibrin sealant and

sutures for conjunctival autograft fixation in pterygium surgery: one-year follow-up. Ophthalmologica 2008;222(2):105-11.

2. Karalezli A, Kucukerdonmez C, Akova YA, et al. Fibrin Glue versus Sutures for Conjunctival Autografting in Pterygium Surgery: a Prospective Comparative Study. Br J Ophthalmol 2008;92(9):1206-21.

3. Ozdamar Y, Mutevelli S, Han U, et al. A Comparative Study of Tissue Glue and Vicryl Suture for Closing Limbal Conjunctival Autografts and Histologic Evaluation after Pterygium Excision. Cornea 2008;27(5):552-558.

4. Bahar I, Weinberger D, Gaton DD, et al. Fibrin Glue versus Vicryl Sutures for Primary Conjunctival Closure in Pterygium Surgery: Long-term Results. Curr Eye Res 2007;32:399-405.

5. Marticorena J, Rodriguez-Ares MT, Tourino R, et al. Pterygium Surgery: Conjunctival Autograft Using Fibrin Adhesive. Cornea 2006;25:34-6.