J.Talajic, K. Miszkiewicz, L. Racine, M. Harissi-Dagher

1
Fibrin Glue versus Nylon Sutures
for Conjunctival Autografting
in Pterygium Surgery

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

2
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.

3
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

4
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.

5
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

6
RESULTS
SUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION WITH CONJUNCTIVAL AUTOGRAFT SUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION WITH CONJUNCTIVAL AUTOGRAFT SUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION WITH CONJUNCTIVAL AUTOGRAFT SUMMARY 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 0.400
Ethnicity ( Caucasian) 45.5 75 0.214
Eye ( OD) 45.5 41.7 0.256
Surgery duration (min per pterygium) 25.1 25.3 0.457
Mean F/U (months) 7.4 11.3 0.609
Graft Success () 96 100 1.0
Recurrence () 27.3 8.3 0.317
7
FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP FIBRIN GLUE GROUP
Patient Age (years) Sex Ethnicity Eye and location Surgery duration (min) Mean F/U (months) FBS Postop Recurrence Recurrence Graft Success
1 35 M African OS nasal 35 8.2 No No No Yes
2 39 M African OS nasal 20 5.6 PO day 1 No No Yes
3 45 M Hispanic OD nasal 35 1.4 No No No Yes
4 45 M Asian OD nasal temporal 25 9 PO month 1 Yes (nasal temp) Yes (nasal temp) Temp Yes Nasal No.
5 49 M Caucasian OS nasal 38 10.4 PO day 1 Yes Yes Yes
6 54 M Black OD temporal 25 17.5 No No No Yes
7 63 F Caucasian OS nasal 19 9.6 No No No Yes
8 71 M Caucasian OS nasal 36 6.1 No Yes Yes Yes
9 73 F Caucasian OD temporal 21 5.2 No No No Yes
10 76 M Hispanic OD nasal 25 3.5 PO day1 No No Yes
11 79 F Caucasian OS nasal 30 4.5 PO day 1 No No Yes
NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP NYLON SUTURE GROUP
1 31 F Hispanic OS nasal 24 19.5 PO week 1 PO week 1 No Yes
2 41 F Caucasian OS nasal 23 11.4 PO week 1 PO week 1 No Yes
3 44 M Caucasian OD nasal 30 18.2 PO week 1 PO week 1 No Yes
4 48 F Caucasian OD nasal 22 10 PO month 1 PO month 1 No Yes
5 50 M Hispanic OS nasal 25 8.3 PO month 1 PO month 1 No Yes
6 50 M Caucasian OD nasal 29 7.1 PO week 1 PO week 1 No Yes
7 54 F Black OS nasal 28 17.2 PO week 1 PO week 1 No Yes
8 57 F Caucasian OS nasal 20 6.7 PO week 1 PO week 1 Yes Yes
9 60 M Caucasian OD nasal 25 7.6 PO week 1 PO week 1 No Yes
10 61 F Caucasian OS nasal 24 9.5 PO week 1 PO week 1 No Yes
11 63 M Caucasian OD nasal 27 6 No No No Yes
12 65 M Caucasian OS nasal 30 14 PO week 1 PO week 1 No Yes
8
(No Transcript)
9
CONCLUSION

• This 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.

10
REFERENCES

•  
• 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 2008222(2)105-11.
• 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 200892(9)1206
  -21.
• 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 200827(5)552-558.
• 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 200732399-405.
• Marticorena J, Rodriguez-Ares MT, Tourino R, et
  al. Pterygium Surgery Conjunctival Autograft
  Using Fibrin Adhesive. Cornea 20062534-6.