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Lena Dixit, Todd Shepler; Use of Evicel as a Fibrin Adhesive in Pterygium Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2128.
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To evaluate Evicel as a safe and effective fibrin adhesive for amniotic membrane graft fixation during pterygium surgery. Evicel is derived from pooled human plasma, whereas the gold-standard fibrin adhesive used in ophthalmology, Tisseel, contains human and synthetic components. Tisseel requires extensive preparation and handling prior to its use. Evicel may be equal or more effective than Tisseel during pterygium surgery without the same preparation and handling. Previous literature has shown that Evicel’s clot integrity is mechanically superior to Tisseel’s which may be advantageous when fibrin glue is utilized as an adhesive rather than a hemostatic agent.
Consecutive cases of 96 patients who underwent primary pterygium surgery with amniotic membrane placement from 1 week to 8 months in the postoperative period were included in this study. Of these patients, 59 were treated with Evicel and 37 were treated with Tisseel to adhere an amniotic membrane graft to the sclera after pterygium excision. Post-operative complications of recurrence, pyogenic granuloma, and conjunctival cysts were clinically assessed. Proportions of each complication were calculated and analyzed with statistical significance at p < 0.05.
Mean patient age was 46 ± 12 (SD) (range 18-70) in the Evicel group, and 46 ± 11 (SD) (range 27-74) in the Tisseel group. In the Evicel group, 6.8% of patients developed a recurrent pterygium, 6.8% developed a pyogenic granuloma, and 3.4% developed a conjunctival cyst. In the Tisseel group, 2.7% developed a recurrent pterygium, 2.7% developed a pyogenic granuloma, and 2.7% developed a conjunctival cyst. An unpaired two-sample t-test between proportions showed there was no difference in the rates of pterygium recurrence (t value = 0.97, degrees of freedom = 93.9, two-tailed p value = 0.33), no difference in formation of pyogenic granuloma (t value = 0.97, degrees of freedom = 93.9, two-tailed p value = 0.33), and no difference in formation of conjunctival cyst (t value = 0.2, degrees of freedom = 89.9, two-tailed p value = 0.84).
There is no difference in the development of postoperative complications between Evicel and Tisseel when used as an adhesive during pterygium surgery. Evicel is a safe and effective fibrin adhesive for amniotic membrane graft fixation after pterygium excision.
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