Transcript Fibrin Glue versus Nylon Sutures for Conjunctival

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.
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
2
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
RESULTS
SUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION WITH
CONJUNCTIVAL AUTOGRAFT
FIBRIN
NYLON
P Value
GLUE
SUTURES
Age (years)
57.2
51.2
0.355
Sex (%Male)
73
50
0.400
Ethnicity (% Caucasian)
45.5
75
0.214
Eye (% OD)
Surgery duration
(min per pterygium)
Mean F/U (months)
Graft Success (%)
Recurrence (%)
45.5
41.7
0.256
25.1
25.3
0.457
7.4
96
27.3
11.3
100
8.3
0.609
1.0
0.317
6
Age
Patient (years Sex
)
1
35
M
2
39
M
Ethnicity
African
African
3
45
M
Hispanic
4
45
M
Asian
5
49
M
Caucasian
6
54
M
Black
7
8
63
71
F
M
Caucasian
Caucasian
9
73
F
Caucasian
10
11
76
79
M
F
Hispanic
Caucasian
1
2
3
4
5
6
7
8
9
10
31
41
44
48
50
50
54
57
60
61
F
F
M
F
M
M
F
F
M
F
Hispanic
Caucasian
Caucasian
Caucasian
Hispanic
Caucasian
Black
Caucasian
Caucasian
Caucasian
FIBRIN GLUE GROUP
Mean
Eye and
Surgery
F/U
FBS Postop Recurrence
location duration (min)
(months)
OS nasal
35
8.2
No
No
OS nasal
20
5.6
PO day 1
No
OD nasal
35
1.4
OD nasal &
25
9
temporal
OS nasal
38
10.4
OD
25
17.5
temporal
OS nasal
19
9.6
OS nasal
36
6.1
OD
21
5.2
temporal
OD nasal
25
3.5
OS nasal
30
4.5
NYLON SUTURE GROUP
OS nasal
24
19.5
OS nasal
23
11.4
OD nasal
30
18.2
OD nasal
22
10
OS nasal
25
8.3
OD nasal
29
7.1
OS nasal
28
17.2
OS nasal
20
6.7
OD nasal
25
7.6
OS nasal
24
9.5
Graft
Success
Yes
Yes
No
No
Yes
Yes (nasal Temp: Yes
PO month 1
& temp) Nasal: No.
PO day 1
Yes
Yes
No
No
Yes
No
No
No
Yes
Yes
Yes
No
No
Yes
PO day1
PO day 1
No
No
Yes
Yes
PO week 1
PO week 1
PO week 1
PO month 1
PO month 1
PO week 1
PO week 1
PO week 1
PO week 1
PO week 1
No
No
No
No
No
No
No
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes7
Yes
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
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):120621.
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.