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F. C. Figueiredo, K. H. Aye, S. B. Kaye, K. Gales, S. Kolli, A. W. Ferguson; Fibrinogen Glue as an Alternative to Sutures in Pterygium Excision Combined With Conjunctival Autograft. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6026.
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To assess the efficacy, safety, and refractive effect of the use of fibrinogen glue in pterygium excision with conjunctival autograft, compared to conventional suture technique.
This was a retrospective single centre UK study of 32 consecutive patients undergoing pterygium excision using fibrinogen glue to secure the conjunctival autograft (group A), from 2005 to 2007, under a single surgeon (FCF). Outcomes were compared with 32 matched pterygium excisions using sutures to secure the autograft (group B). Both groups underwent detailed pre- and post-operative assessment at 3 and 6 months, including corneal topography. Refractive analysis was performed using the method of Kaye & Harris.
Mean follow-up was 6.4 months (range 5-12) in group A and 8.9 months (range 5-25) in group B. Mean age was 50 years in group A, compared to 49.5 years in group B. The male to female ratio was 1.3 in the group A and 1.9 in group B. In both groups 50% of pterygia were grade 1 (2-3mm), 28% were grade 2 (3.5-5 mm) and 22% grade 3 (>5 mm). Recurrence rate of pterygium was 3.2% (one patient) in each group. Other minor complications noted were 4 cases of partial wound dehiscence and one case of temporary postoperative diplopia in group A, and 4 exposed sutures and 2 epithelial defects both temporary in group B. Best corrected visual acuity was equal pre-operatively (0.00 LogMar), and improved in both groups post-operatively, with no significant difference between the groups (-0.04 in group A, -0.01in group B; p=0.82). There was no significant difference in pre-operative refractive error between the 2 groups (group A +0.60/ +1.14, Group B +0.74/+0.98; p=0.456). Post-operatively there was however, a significant reduction in the refractive error in group A at 6 months (+0.15/+0.09; p=0.046). Although group B showed a similar trend, the refractive change in this group was not significant (+0.78/+0.18; p=0.184).
The use of fibrinogen glue to secure conjunctival grafts in pterygium surgery is as efficient as the conventional suturing method, with no increase in recurrence rate or other significant complications. There is however a higher rate of partial wound dehiscence - although this was not shown to affect surgical outcome. Importantly, fibrinogen glue led to a significant reduction in the refractive error compared to the use of sutures. This study supports the use of fibrinogen glue as an alternative to sutures in pterygium surgery with conjunctival autograft.
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