Comparison of Fibrin Sealant and Sutures for Conjunctival Autograft Fixation in Pterygium Surgery: One-Year Follow-Up

The effect of cyclosporine a in pterygium surgery using fibrin glue

BACKGROUND/OBJECTIVES

To evaluate the effect of topical cyclosporine A (CsA) 0.05% in patients with pterygium surgery using fibrin glue (FG).

SUBJECTS/METHODS

Patients with primary nasal pterygium were retrospectically analyzed and categorized into two groups: Group 1 with 41 eyes from 38 patients as a control group and group 2 with 39 eyes from 36 patients who received topical CsA twice a day for 6 months. Patients were assessed for recurrence rate, tear film parameters, side effects, and complications at postoperative intervals of 1-7 days; 1st, 3rd, 6th and 12th months. The follow-up period was 1 year.

RESULTS

The two groups were age (p = 0.934) and sex (p = 0.996) matched. CsA drop was discontinued in one patient due to burning sensation and conjunctival hyperemia after 1 week. There was no statistically significant difference between the mean preoperative and postoperative 1st year Schirmer I and tear break-up time (TBUT) values in group 1 (p = 0.136; p = 0.069). Although the difference between the mean preoperative and postoperative 1st year TBUT values in group 2 was not statistically different (p = 0.249), Schirmer I results were higher postoperatively (p = 0.003). There was no statistically significant difference between preoperative Schirmer (p = 0.496), postoperative Schirmer (p = 0.661), preoperative TBUT (p = 0.240) and postoperative TBUT (p = 0.238) results of the two groups. Recurrence was observed in only one patient from group 1.

CONCLUSION

No recurrent pterygium cases were observed in group 2. Schirmer I values were higher postoperatively in group 2; thus,topical CsA treatment may improve lacrimal secretion and be effective after pterygium surgery with FG.

Sensory Changes in the Ocular Surface After Pterygium Removal

Purpose

We measure changes in ocular surface sensation after pterygium surgery with a conjunctival autograft.

Methods

This prospective, interventional study was carried out in patients, with nasal primary pterygium undergoing pterygium surgery with conjunctival autograft. Sensation was measured by applying the tip of the Cochet-Bonnet esthesiometer filament perpendicular to the ocular surface in the cornea and conjunctiva. Patients were tested preoperatively (baseline), and at 2 weeks, 2 and 4 months, postoperatively.

Results

Nineteen eyes of 18 patients completed the 4-month follow-up. Mean age was 61±10.1 (range 36-76) years. Corneal sensation returned to normal values in all at 2 and at 4 months. The central cornea was significantly more sensitive compared to the average of the four peripheral measurements pre- (59.2 mm vs 48.3 mm, p=0.000) and postoperatively (59.2 mm vs 48.4 mm, p=0.000). Conjunctival sensation was reduced significantly 2 months postoperatively in the inferior region (p=0.04). Four months postoperatively, it was more sensitive in the superior area (13.9 mm vs 17.1 mm, p=0.01) and the inferior area (13.7 mm vs 19.5 mm, p=0.003). In each matching area, the cornea was significantly more sensitive than the conjunctiva pre- and postoperatively (p=0.00). Sensation was not significantly different between the sexes or age groups.

Conclusion

This study demonstrates the presence of inferior and superior conjunctival hyperesthesia at conjunctival autograft sites after pterygium surgery. The healing process, sensory input, tear film instability and epitheliopathy of the ocular surface are possible explanations for these novel findings.

Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts

Purpose

To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery.

Methods

We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm 2 ) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence.

Results

The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm 2 ) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4).

Conclusion

RS, by augmenting the autologous blood mechanism, may offer an easy to learn option for pterygium surgery with good stability even in large sized CAGs.

Pterygium excision with conjunctival autograft fixed with sutures, glue, or autologous blood

AIMS AND OBJECTIVES

This retrospective study compared surgical outcome of pterygium excision with conjunctival autograft fixed with sutures, tissue glue or autologous blood in relation to recurrence rate and surgical complications.

MATERIALS AND METHODS

Surgical records of 148 patients operated for excision of primary nasal pterygium with conjunctival autograft were reviewed retrospectively for the period between January 2015 and June 2018. Based on surgical technique used to fix the graft, patients were divided into three groups. In Group A, 8 "0" vicryl suture was used to fix the graft in 90 patients. In Group B, fibrin glue was used to fix the graft in 23 patients. In Group C, autologous blood was used to fix the graft in 35 patients. Patients who were operated by single surgeon and had followed up for minimum six months were included in the study.

RESULTS

Group A had recurrence in 7 cases (7.78%) whereas; Group B and C had no recurrence. But, in Group C two patients (5.71%) lost their graft. Overall recurrence rate in the study was 4.72%.

CONCLUSION

Among the three techniques used in the study, recurrence was seen in the suture group and autologous blood group had loss of graft. The fibrin glue group was free of complications.

Early postoperative outcomes of pterygium surgery: Sutures versus autogenous serum in-situ fixation of limbal conjunctival autograft

Limbal Conjunctival Autograft Transplantation (LCAT) is considered to be the most effective treatment option for pterygium with the least recurrence rate and rapid restoration of normal epithelial morphology. Of the many available methods for securing Limbal Conjunctival Autograft (LCAG), sutures and autogenous serum in-situ are cost-effective and offers better outcomes.

AIM

To compare the outcome of surgeries between the two groups: Group I - LCAG secured with autogenous serum in-situ versus Group II - LCAG secured with sutures.

MAIN METHODS

A prospective randomized control trial conducted on 60 patients who were equally divided into two groups. Post-operative follow-up visits were scheduled at 1st week, 3rd week and 6th week. They were examined for pain, foreign body sensation, subconjunctival hemorrhage, tearing, hyperemia, graft edema, graft displacement, graft retraction, recurrence and/or any other complications and were graded depending on the severity. Mean surgical time was compared between the two groups.

KEY FINDINGS

Average duration of surgery was significantly less in Group I than in Group II. Postoperatively, symptoms like pain, foreign body sensation, tearing and hyperemia were less common in Group I, furthermore subconjunctival hemorrhage and graft edema were more in Group II.

SIGNIFICANCE

Though both the procedures are safe and effective, the use of autogenous serum in-situ significantly shortens the duration of surgery and is accompanied by lesser postoperative discomfort and inflammation. However, long-term studies are needed to assess the risk of recurrence. Graft displacement remains a severe, but infrequent complication.

Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence

Previous meta-analyses have been conducted to compare the efficacy of fibrin glue (FG) versus sutures in pterygium surgery; however, additional clinical trials have since been published. Therefore, we conducted an updated meta-analysis to further explore the association between FG application in pterygium surgery, and the recurrence rate, complication rate, and surgical duration. An electronic literature search for eligible studies published before July 29, 2016 was conducted across multiple databases. Odds ratios (ORs), standardized mean difference (SMD), and 95% confidence intervals (CI) were calculated. Publication bias of the included articles was evaluated by funnel plots. Differences in recurrence rate and complication rate between the FG and suture groups were evaluated in terms of OR with 95% CI, and SMD with 95% CI were used to estimate the difference in surgical duration. Trial sequential analysis (TSA) was used to determine whether the currently available evidence was sufficient and conclusive. Twenty-four studies were included in this study. The pooled ORs for recurrence rate and complication rate were 0.35 and 1.121, respectively. The pooled SMD for surgical duration was −4.142. The TSA results indicated that evidence of the effect was sufficient in the recurrence group and surgical duration group. Although there was no difference in complication rate between FG and sutures, the apparent advantages of FG over sutures are shorter surgical duration and greater reduction in the recurrence rate of pterygium.

Comparison of self-made cryopreservative fibrin glue and commercial fibrin glue kit in pterygium surgery: 1-year follow-up

PURPOSE

To assess long-term efficacy and safety of self-made cryopreservative fibrin glue (SMC) applied in pterygium surgery.

METHODS

Prospective, comparative, interventional case series. Forty eyes of 40 patients with nasal primary pterygium, 24 male and 16 female, were enrolled. The patients were assigned to two groups and each contained 12 male and eight female based on the pterygium area encroaching onto the cornea. In one group, the conjunctival autograft was attached to the sclera with SMC stored for 2 months, and in the other group, commercial fibrin glue kit (CK) was applied after the pterygium was removed. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 3, 6, 12. The main outcome measures included operating time, postoperative discomfort, recurrence rate and complications.

RESULTS

There were no significant differences in surgery time (p = 0.713) and postoperative discomfort (day 1, 3, 7; p = 0.747, p = 0.766, p = 0.983, respectively) between the two groups. By the end of 1-year follow-up, the recurrence rate was 0% in the SMC group and 5% in the CK group (p = 1.000). There were no infections and severe visual acuity (VA) threatening complications in either group.

CONCLUSION

Self-made cryopreservative fibrin glue (SMC) is as effective as standard CK for autograft fixation in pterygium surgery and it also has good safety after long-term follow-up. For its convenience and low cost, this new methods should be popularized, especially in underdeveloped area.

The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms

BACKGROUND

Fibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use.

OBJECTIVES

To systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults.

DATA SOURCES

Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms.

REVIEW METHODS

This review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis.

RESULTS

We included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04; p = 0.13; I² = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01; I² = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays.

LIMITATIONS

It was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available.

CONCLUSIONS

The effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42015020710.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Releasable Single Suture for Primary Pterygium Excision With a Conjunctival Autograft

PURPOSE

To evaluate the efficacy of a releasable single suture for pterygium excision with a conjunctival autograft (CAG).

METHODS

Retrospective case series at a tertiary eye care center in central India was conducted. Medical records of 150 patients, who underwent primary pterygium excision with a CAG secured by a single releasable 10-0 nylon suture in the last year were reviewed. The surgical duration was noted. The suture was released on the first postoperative day under topical anesthesia. Patients were followed up until 1 year. At each visit, factors studied were patient comfort [pain grading on a visual analog scale], graft apposition, complications, and recurrence.

RESULTS

Mean age of patients was 39 ± 11 years. Most patients in our study were female (58.7%). Sixty percent of pterygia were of Tan grade 2. The mean duration of surgery was 4.8 ± 1.3 minutes. The maximum size of the CAG was 6 mm (3-6 mm). The graft retraction rate was 5.3% (1 mm retraction in the CAG more than 5.5 mm) with no event of graft loss. Four percent of patients had grade 1 recurrence.

CONCLUSIONS

Releasable single suture may offer a good and simple alternative, which uses the gold standard technique of the CAG with exclusion of suture-related complications.

Self-made cryopreservative fibrin glue applied in pterygium surgery: a novel practical technique

PURPOSE

To introduce a novel practical technique of self-made cryopreservative fibrin glue (SMC) applied in pterygium surgery and to assess its safety and efficacy.

METHODS

Forty-eight eyes of 48 patients with nasal primary pterygium were enrolled. The patients were equally assigned to 6 groups. Self-made fibrin glue was subpackaged and, respectively, cryopreserved for 3, 7, 15 days and 1, 2 and 3 months. At each time point, the asepsis of SMC was confirmed by bacterial culture and colony counting. In each group, corresponding SMC was applied to fix the autograft after the pterygium was removed (e.g., SMC 3d for group 1 and SMC 3m for group 6). All the patients were followed up postoperatively on days 1, 3, 7 and 14 and then at months 1, 3, 6. The main outcome measures included fixation success rate within two tries, postoperative discomfort, recurrence rate and complications.

RESULTS

No colony growth was observed in all the fibrinogen and thrombin tubes sent. Five patients needed a second try with respective SMC during the autograft fixation, and there were no significant differences in SMC use times among the groups (P = 0.885). There were no significant differences in postoperative discomfort (day 1, 3, 7; P = 0.651, P = 0.269, P = 0.180, respectively) among the groups. By the end of 6-m follow-up, no infections and severe complications were observed in any group. The total recurrence rate was 3/48 (6%), and there were no significant differences in recurrences among the groups (P = 1.000).

CONCLUSION

SMC is safe and effective for autograft fixation in pterygium surgery. This new practical technique will benefit the patients and surgeons in developing and underdeveloped country.

Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery

BACKGROUND

Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages 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. Currently the best surgical option in terms of recurrence is conjunctival autograft. To date the most common surgical methods of attaching conjunctival autografts to the sclera are through suturing or fibrin glue. Each method presents its own advantages and disadvantages. Sutures require considerable skill from the surgeon and can be associated with a prolonged operation time, postoperative discomfort and suture-related complications, whereas fibrin glue may give a decreased operation time, improve postoperative comfort and avoid suture-related problems.

OBJECTIVES

To assess the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2016), Embase (January 1980 to October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 October 2016.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in any setting where fibrin glue was compared with sutures to treat people with pterygium.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. Our primary outcome was recurrence of pterygium defined as any re-growth of tissue from the area of excision across the limbus onto the cornea. The secondary outcomes were surgical time and complication rate. We graded the certainty of the evidence using GRADE.

MAIN RESULTS

We included 14 RCTs conducted in Brazil, China, Egypt, India, Malaysia, New Zealand, Philippines, Saudi Arabia, Sweden and Turkey. The trials were published between 2004 and 2016, and were assessed as a mixture of unclear and low risk of bias with three studies at high risk of attrition bias. Only adults were enrolled in these studies.Using fibrin glue for the conjunctival autograft may result in less recurrence of pterygium compared with using sutures (risk ratio (RR) 0.47, 95% CI 0.27 to 0.82, 762 eyes, 12 RCTs; low-certainty evidence). If pterygium recurs after approximately 10 in every 100 surgeries with sutures, then using fibrin glue may result in approximately 5 fewer cases of recurrence in every 100 surgeries (95% CI 2 fewer to 7 fewer cases). Using fibrin glue may lead to more complications compared with sutures (RR 1.92; 95% CI 1.22 to 3.02, 11 RCTs, 673 eyes, low-certainty evidence). The most common complications reported were: graft dehiscence, graft retraction and granuloma. On average using fibrin glue may mean that surgery is quicker compared with suturing (mean difference (MD) -17.01 minutes 95% CI -20.56 to -13.46), 9 RCTs, 614 eyes, low-certainty evidence).

AUTHORS' CONCLUSIONS

The meta-analyses, conducted on people with pterygium in a hospital or outpatient setting, show fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. There was low-certainty evidence to suggest a higher proportion of complications in the fibrin glue group.

Comparison of intra-operative 0.02% mitomycin C and sutureless limbal conjunctival autograft fixation in pterygium surgery: five-year follow-up

PURPOSE

To compare efficacy and safety between fibrin sealant assisted limbal conjunctival autograft fixation and intra-operative MMC in pterygium surgery.

METHODS

Prospective, comparative, interventional case series. Forty eyes of 40 patients with nasal primary pterygium, 18 male and 22 female, were enrolled. The patients were assigned to two groups, and each contained nine male and 11 female based on the pterygium area encroaching onto the cornea. In one group, the conjunctival autograft was attached to the sclera with fibrin sealant, and in the other group, 0.02% MMC was applied after the pterygium was removed. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 2, 6, 12 and 60. The main outcome measures included operating time, postoperative discomfort, cornea endothelial damage, recurrence rate and complications.

RESULTS

The average operating time was significantly shorter (p = 0.044) in the fibrin sealant group, and fewer postoperative symptom complaints were received as well. On postoperative month 1, no significant differences in the mean endothelial cell count, mean CV and mean 6A% were observed between these two groups. By the end of 5-year follow-up, the recurrence rate was 0% in the fibrin sealant group and 20% in the MMC group (p = 0.106), and there were no severe visual acuity threatening complications in either group.

CONCLUSION

There were no severe complications after long-term follow-up if intra-operative MMC was strictly and carefully used. Overall, this sutureless method is more effective than traditional MMC.

Ophthalmic use of blood-derived products

There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.

Long-term comparison of fibrin tissue glue and vicryl suture in conjunctival autografting for pterygium surgery

PURPOSE

Pterygium is a common clinical entity that usually causes visual impairment, astigmatism and cosmetic problems. Although many surgical techniques to treat pterygium have been proposed, no single method, with minimal patient complications, has yet been accepted and established. Excision combined with conjunctival autograft is the most often used procedure for the treatment of primary pterygium, and the technique is associated with minimized recurrence rates in patients. The purpose of our study was to compare visual and refractive outcomes, complications, and recurrence rates with the use of fibrin glue versus 8.0 vicryl suture in pterygium surgery performed with conjunctival autograft.

MATERIALS AND METHODS

Our retrospective, comparative study included 106 eyes of 106 patients operated on for primary pterygium, between the years 2011 and 2012, and followed for ≥ 12 months. Patients were divided into 2 treatment groups: Group 1, vicryl suture use (n = 53), and Group 2, fibrin tissue glue (n = 53). Patient follow-up periods were 21.15 ± 5.3 months for Group 1 and 22.06 ± 5.2 months for Group 2.

RESULTS

Demographics and preoperative/follow-up clinical characteristics of patients revealed no significant differences between the 2 patient groups. Additionally, no significant differences were found between the patient groups in visual acuity level changes and refractive values. Although the rates of recurrence (7.5% in Group 1 and 1.9% in Group 2; P = 0.36) and graft dehiscence (Group 1, 7.5% compared with Group 2, 3.8%; P = 0.67) were slightly higher for patients in the suture group, differences did not reach significance.

CONCLUSIONS

Our study results suggest that conjunctival autografting with fibrin glue has favorable visual and refractive results for patients, and is associated with lower complication rates, compared with use of the traditional 8.0 vicryl suturing technique. We suggest that fibrin tissue glue provides adequate adhesion and that graft loss will not be a problem if protective shields are used in patients postoperatively. The appropriate surgery technique should be selected by considering the advantages and disadvantages of each procedure.

Pterygium recurrence, astigmatism and visual acuity following bare-sclera excision and conjunctival autograft with or without additional phototherapeutic keratectomy

BACKGROUND

Treatment outcome in patients with pterygium following bare-sclera excision and conjunctival autograft (CAG) with and without phototherapeutic keratectomy (PTK).

METHODS

Retrospective comparative analysis of 81 eyes, with primary and recurrent pterygia, that were analyzed for recurrence, best-corrected visual acuity (BCVA) and astigmatism in primary (P1 without PTK, P2 with PTK) and recurrent pterygia (R1 without PTK, R2 with PTK). BCVA and astigmatism were compared in patients with simple CAG alone (group I) or in combination with PTK (group II).

RESULTS

Recurrence rates were 4.7, 11.6, 16.2, 23.2 and 32.5% at 3, 6, 12, 24 and >24 months (P1), 7.1% at >24 months (P2). Recurrence rates were 5.3, 10.5, 21.1, 21.1 and 26.3% at 3, 6, 12, 24 and >24 months (R1) and 1 recurrence (7.7%) till month 24, and 3 (23.1%) thereafter (R2). BCVA increased from logarithm of the minimal angle of resolution 0.095 ± 0.141 (mean ± SD) at baseline to 0.066 ± 0.09 (group I), and from 0.090 ± 0.164 to 0.054 ± 0.124 (group II). Astigmatism decreased from -1.01 ± 0.90 dpt at baseline to -0.97 ± 1.24 dpt (group I), and from -1.19 ± 1.55 to -0.75 ± 0.87 dpt (group II).

CONCLUSION

In comparison to CAG alone, additional excimer smoothing with PTK tends to increase BCVA and reduces recurrence rates in patients with primary pterygia.

Fibrin glue-assisted fixation of decentered posterior chamber intraocular lens

OBJECTIVE

To report the feasibility and outcome of the technique of glue-assisted fixation of decentered posterior chamber intraocular lens (PCIOL) in the posterior chamber using the same IOL.

METHODS

The procedure was performed in three eyes having decentered PCIOL with inadequate capsular rim to support the IOL. The haptics were exteriorized under a partial thickness scleral flap at 1.5 mm behind the limbus and placed into a partial thickness scleral pocket and fixed with fibrin glue. No suture was placed at any site.

RESULTS

On day 1 and at 6 weeks, the IOLs were well centered. There was no significant anterior or posterior segment inflammation, and the intraocular pressure was normal.

CONCLUSION

Fibrin glue-assisted fixation of PCIOL is a feasible technique with good outcome in eyes with decentered IOL with inadequate capsular support.

Safety and efficacy of fibrin glue versus vicryl sutures in recurrent pterygium with amniotic membrane grafting

PURPOSE

The study aimed to compare surgical outcomes with likely toxic side effects when using pterygium excision and amniotic membrane grafting with fibrin glue versus Vicryl sutures.

METHOD

This is a prospective randomized study. Patients were classified into two groups: group 1 consisted of 20 patients with Vicryl-sutured grafts, and group 2 consisted of 20 patients with fibrin-glued grafts that were prepared from autologous blood. Results including surgery time, patient discomfort, complications and recurrence rates within 1, 6 and 12 months were analyzed.

RESULTS

The study demonstrated that there was a statistically significant decrease in surgery time in the fibrin glue group (the procedure took 17 min) relative to the sutured group (28 min; p < 0.05). Additionally, both postoperative pain and discomfort were noted significantly less often in the fibrin glue group. Complications were also decreased in the fibrin glue group.

CONCLUSION

The study revealed that the use of fibrin glue in pterygium surgery with amniotic membrane grafting was safer, less toxic and less time-consuming, and resulted in fewer complications than graft surgery with sutures.

Ropivacaine for topical anesthesia in pterygium surgery with fibrin glue for conjunctival autograft

PURPOSE

To evaluate efficacy of ropivacaine 1% for topical anesthesia in pterygium surgery with conjunctival autograft using fibrin glue for attaching the graft to the bare sclera.

METHODS

Thirty-seven patients affected by primary pterygium underwent surgical excision under topical anesthesia with ropivacaine 1%. We performed a surgical approach with dissection of the pterygium, scraping of corneal bed with a motorized burr, meticulous excision of underlying Tenon's capsule, preparation of a free autologous conjunctival graft in the superior sector, excision of the graft, and position of the same to cover the scleral bed exposed in the nasal area with respect to limbus and stromal orientation fixing the graft with fibrin glue.

RESULTS

It was possible to perform all the procedures without any supplemental anesthesia and sedation. The pain reported by patients, recorded by a 0 to 10 scale, was low during the entire surgery. The technique with conjunctival autograft using a fibrin sealant allowed for short operative times and good aesthetic and functional results.

CONCLUSIONS

Topical anesthesia with ropivacaine is safe and effective in pterygium surgery. The Long-lasting anesthesia with this agent permitted performing our surgical procedures with autograft conjunctival graft and fibrin glue to attach the flap with low pain perceived by our patients, low surgical invasivity, and short duration of surgery.

[Operative techniques for surgical treatment of primary and recurrent pterygia]

Surgical treatment of pterygia is indicated when there is a reduction of visual acuity secondary to the development of irregular astigmatism and an (impending) obscuration of the visual axis by the tumor. Poor cosmetic appearance and an insufficient corneal lubrication are more rare indications. The most popular surgical technique in this country appears to be a free conjunctival autograft which, depending on the priority of the surgeon, is combined with adjunctive antimetabolite therapy applied either in primary or recurrent cases. A simultaneous transplantation of conjunctival and limbal stem cell autografts is an excellent method to be considered particularly in cases of recurrent pterygia. In the case of non-existing healthy autologous tissue the resection bed can be covered by preserved amniotic membrane. A lamellar sectorial corneal graft might become necessary if there is a deep corneal defect. The well established technique of suturing the graft has been replaced by fibrin glue in some surgical centers.

Cut and paste: a novel method of re-attaching rectus muscles with cyanoacrylate during recessions in strabismus

Aim:

Bio-adhesives like cyanoacrylate offer an alternative to sutures to attach tissues, including in ophthalmology. This prospective trial evaluated the suitability and bio-tolerance of iso-amyl cyanoacrylate in rectus muscle recession surgery for strabismus.

Materials and Methods:

We randomized one eye in each of 10 cases of bilateral horizontal rectus recessions to 6/0 polyglactin and the other to iso-amyl-cyanoacrylate. We compared time to reattachment (from disinsertion), complications and inflammatory scores (0 to +3: nil, mild, moderate and severe) on Day One, at two and at four to six weeks post surgery.

Results:

There were no significant group differences in inflammatory scores (Wilcoxon, all values of P>0.05). All attachments held firm. Gluing took significantly longer by 5.24±1.91 min (95% CI for difference: 3.87-6.61). There were no complications.

Conclusion:

We feel that although it takes marginally longer, iso-amyl cyanoacrylate offers an effective and safe alternative to sutures for muscle recession in strabismus surgery. Since it is cheaper (vs. polyglactin) and offers multi-use possibility it may also prove to be cost-effective.

Fibrin glue in ophthalmology

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.

"Bleb window"-pexy for the management of symptomatic, oversized blebs

PURPOSE

To describe a simple method and outcomes of remodeling dysesthetic, oversized filtering blebs.

PATIENTS AND METHODS

Retrospective chart review of the initial consecutive patients who had undergone "bleb window"-pexy (BWP) over a 1-year period. Patients with symptomatic, oversized, and dysmorphic blebs that did not show signs of spontaneous resolution were candidates for the technique, regardless of the intraocular pressure. Under topical anesthesia, a conjunctival window was created in the filtering bleb at the palpebral fissure (nasal or temporal) using Westcott scissors. The cut edges of conjunctiva and Tenon capsule were then glued to the underlying bare sclera using autologous fibrin tissue glue. In the case of extended (360 degrees) blebs (2 patients), 2 conjunctival windows were performed (nasal and temporal). Main outcome included symptomatic relief, restoration of bleb architecture, and preservation of filtration.

RESULTS

Six eyes from 6 patients underwent BWP. The mean follow-up period was 6.6+/-1.7 months (3.5 to 8.3 mo). All patients documented a rapid symptomatic relief within the first postoperative day. All had successful reduction in bleb size and adequate filtration without further antiglaucoma medications or surgery. Best corrected visual acuity improved 2 Snellen lines in 1 eye. Lens status remained unchanged in all cases. No complications or recurrences were noted.

CONCLUSIONS

Early results showed that BWP is safe, easy, and minimally invasive technique for the rapid relief of dysesthesia symptoms from dysmorphic filtering blebs. A larger sample size with longer follow-up is necessary to confirm the clinical utility.