A Comparative Study To Evaluate The Outcome Of Sutures Versus Fibrin Glue In Conjunctival Autograft Technique For Primary Pterygium Excision

Abstract

Background: Pterygium is degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue and is characterized by formation of a triangular fold of conjunctiva encroaching on the cornea leading  to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem.  Now, Fibrin glue is being tried since few years to secure grafts in place of the sutures. The objective of this study was to compare duration of surgery, immediate postoperative complications which includes an inflammation, subconjunctival hemorrhage, patient comfort, graft stability between the uses of fibrin glue versus sutures. Methods:  A total of 40 patients having primary pterygium were included in the study. 20 patients were underwent pterygium excision surgery and conjunctival autografting using absorbable vicryl 8-0 suture and 20 patients underwent pterygium excision surgery and conjunctival autografting using fibrin glue.  These 2 groups were compared in terms of duration of the surgery, inflammation, degree of postoperative discomfort, subconjunctival haemorrhage and graft stability at postoperative day 1. Results: The mean surgery time in fibrin glue group was 15 minutes and mean surgery time in suture group was 28 minutes (p=0.000). Fibrin glue group had significantly lesser inflammation (p=0.001) as well as postoperative discomfort (p=0.000) compared to suture group at postoperative day 1. There was no significant difference found in the degree of subconjunctival haemorrhage between the fibrin glue versus sutures groups (p=0.887 and p=0.797 at day 1). The grafts secured with fibrin glue were as stable as those secured with the sutures (p=0.745, 0.644 at day 1). Conclusion: The fibrin glue group in conjuctival autografting had significantly less surgery time, which also produces significantly less postoperative discomfort as well as inflammation with grafts being as stable as those secured with sutures. Fibrin glue can be used regularly if patients can be pooled together and operated on, by making it cost effective procedure.