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Fibrin Glue versus Sutures for attaching the Conjunctival Autograft in Pterygium Surgery: A Prospective Observer Masked Clinical Trial
  1. Sathish Srinivasan (sathish.srinivasan{at}gmail.com),
  2. Michael Dollin,
  3. Penny McAllum,
  4. Yoav Berger,
  5. David S Rootman,
  6. Allan R Slomovic
  1. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada
  2. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada
  3. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada
  4. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada
  5. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada
  6. Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Canada

    Abstract

    Aims: To compare the degree of conjunctival autograft inflammation, subconjunctival hemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery.

    Methods: Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardized digital slit lamp photographs were taken at 1 week, 1 month and 3 months post-operatively. Sutures were masked using commercially available photo editing software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability.

    Results: 34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) post-operatively. No significant difference was found for inflammation at 1 week post-operatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076, and p = 0.624, at 1 week, 1 month, and 3 months, respectively). No significant difference was found in degree of post-operative SCH between the groups (p = 0.417, p = 1, and p = 1, at 1 week, 1 month, and 3 months, respectively).

    Conclusion: This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery are not only as stable as those secured with sutures, but also produce significantly less inflammation.

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