BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - < 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - > 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue
Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial
