Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Network Meta-Analysis of Randomized Trials.

Purpose: To study the efficacy of autologous blood and compare the results with fibrin glue in primary pterygium excision surgery using conjunctival limbal autograft technique. Methods: Prospective, Randomised, interventional, hospital based, comparative study. Sixty eyes of sixty consecutive patients coming to ophthalmology OPD of our tertiary care centre with primary progressive pterygium were selected. Each patient with primary progressive pterygium were randomly assigned to group A and B and were operated. Group A includes 30 patients with conjunctival limbal autograft using autologous blood technique and Group B includes 30 patients with pteryguim excision with conjunctival limbal autografting using fibrin glue. The patients were followed up postoperatively on days 1, 7 and then at months 1, 6, 12 and 18. The main outcome measures included were graft adherence, recurrence rate and postoperative complications. Results: By the end of 18 months follow up, the recurrence rate was 3.33% in fibrin blood group (Group - B) and no recurrence in conjunctival limbal autograft group using Autologous blood (Group - A). There were no severe vision threatening complications in either group. Conclusion: Both the methods of conjunctival limbal autografting using autologous blood and fibrin glue were found to be equally effective and safe in terms of graft adherance and post operative complications. The recurrence rate in autologous blood technique were statistically not significant.

Background: Pterygium is a common ophthalmological problem in India. Excision of pterygium with conjunctival autograft is the main line of treatment. Many modifications of surgical techniques have been tried like conjunctival autografting with fibrin glue, sutures and autologous serum. All these modalities have their pros and cons. We compared these techniques for conjunctival autografting following pterygium surgery. Methods: A randomized interventional study was performed on 60 eyes with primary nasal pterygium. After pterygium excision, the bare sclera was covered with a conjunctival autograft, which was fixed using autologous blood serum(in Group A, n=20), fibrin glue(in Group B, n=20) and vicryl suture (8-0) (in Group C, n=20). The patients were examined on postoperative Day 1, 1 week, 1month, 3 month and 6 month. The main outcome measures were operative time ,autograft stability, postoperative discomfort, autograft thicknes, pterygium recurrence and granuloma formation. Results: The mean operative time was significantly shorter in group A(23.60 min) followed by Group B (25.20 min) and Group C(28.15 min)(p-value <0.0001).Postoperative discomfort measured on visual analogue scale was minimal in fibrin group (p-value=0.0008) and maximum in suture group. Graft displacement was found in 2(10%) patient in autologous blood group (p value=0.349) while Graft oedema, granuloma & recurrence was noted in suture group only(p value=0.362). Conclusions: The conjunctival autografting with fibrin glue proved to be better method than autologous serum and suture, as it had very less postoperative discomfort, no recurrence, minimal edema and less graft displacement.

Aim of the study:evaluate the safety and efficacy of sutureless glue free limbal conjunctival autograft for the management of primary pterygium surgery. Material and method:This prospective,interventional randomized,non comparative study was held at AlZahraaUniversity Hospital between May, 2013 and June, 2015. It included 20 eyes of 17 patients, 12 males(70.6%), and 5 females(29.4%). Their mean age±SD was 52.50±18.31 years (Range:30-75 years). They were presented to the outpatient clinic of Al Zahraa University Hospital with primary pterygium. Inclusion criteria included primary pterygium,non atrophic, with healthy conjunctiva. Exclusion criteria included atrophic pterygium, pseudopterygium, ocular surface pathology, infection, previous limbal surgery or double head pterygium. Surgeries were done under local anesthesia. Simple pterygium excision was done leaving a bare sclera. The size of bare sclera was measured. A conjunctival graft 2 mm larger in width and length than the recipient bed was created from the superior temporal quadrantand was extended to the limbus to include limbal stem cells. The graft was gently moved to the recipient bed with the epithelial side up and keeping the limbal edge toward the limbus.Hemostasis was allowed to occur spontaneously without use of cautery to provide autologous fibrin to glue the conjunctival autograft naturally in position without tension.All patients were followed up after 48 hours, weekly for one month then monthly for 12 months. Results:Pterygia were located nasally in all cases. Pterygia were presented right eye in10(50%) and left eye 10(50%). Mean graft size±SD was 5.5±1.5 millimeter (Range: 5-7 mm). Mean duration of graft fixation ±SD was 10±2.82 minutes (Range:10–12minutes).Mean operative time±SD was 25±1.41 minutes(Range: 24-26 minutes) with good cosmetic outcome in all cases. There was minimal postoperative pain and discomfort, without graft dislocation or dehiscence and without recurrence of pterygia during the follow up period. Conclusion:Sutureless and gluelessconjunctivallimbalautograft following primary pterygium excision is safe,easy,effective and economic technique in primary pterygium surgery.

Aim: To compare the post-operative inflammation, surgical time and complications in conjunctival autografting with oozed autologous blood versus sutures in primary pterygium surgery.
 Study Design: Prospective interventional study.
 Place and Duration of Study: Department of Ophthalmology, CIMS, Bilaspur (C.G), India. (Jan 2017-May 2018).
 Methodology: 80 eyes of 80 patients (25 to 75 years) presented with primary pterygium up to grade 3 were included in this prospective interventional study presented in eye OPD, CIMS, Bilaspur (CG). All the procedures and post-operative evaluation was done by the same surgeon. All the patients were divided into two groups on alternate basis. 40 patients received conjunctival autografting with oozed autologous blood (CAGb) and 40 patients received sutures (CAGs). These two groups were then compared for post-operative inflammation, surgical time and complications (day 1, day 5, 2 weeks, 1 month and 3 month).
 Result: Total 80 patients were evaluated after surgery. Progressive pterygium was observed in more than 50% cases in both groups. Post-operative inflammation and discomfort was significantly lower in CAGb group compared to CAGs group (P<.001). Mean surgical time was also significantly less in CAGb group (11.6±2 min) compared to CAGs group (21.6±3min) (P<.001). In CAGb group 5% patients had graft displacement while none in CAGs group. Granuloma formation was higher in CAGs group (12.5%) compared to CAGb group (7.5%). Subgraft haemorrhage was 10% in CAGb and 17.5% in CAGs group. Dellen formation was seen in 3 patients in CAGb and 4 patients in CAGs. Recurrence rate was higher in suture group (5/40 in CAGs vs 1/40 in CAGb).
 Conclusion: Our study concludes that placement of conjunctival autograft with oozed autologous blood as adhesive after pterygium excision is an effective, less inflammatory and less time consuming approach, with significantly lower rates of post-operative complications. This can be used as a better alternative to suture technique.

Aims: To evaluate the efficacy and safety of fibrin sealant in conjunctival autograft fixation in pterygium surgery. Methods: Prospective, comparative, interventional case series. 40 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 8 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 the other group with nylon 10–0 sutures. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 2, 6 and 12. The main outcome measures included operating time, postoperative symptoms, graft success, recurrence rate and complications. Results: The average operating time was significantly shorter (p < 0.001) in the fibrin sealant group and fewer postoperative symptom complaints were received as well. By the end of 1-year follow-up, the recurrence rate was 5% in the fibrin sealant group and 10% in the suture group (p = 1.000), and there was no statistically significant difference in complications (p > 0.05) between the two groups. Conclusions: It is safe and effective to use fibrin sealant for conjunctival autograft fixation. This method causes much fewer postoperative symptoms and shortens surgery time significantly, and the long-term results are also favorable.

Comparison of Fibrin Glue versus Suture for Conjunctival Autografting in Pterygium Surgery: A Meta-Analysis

To evaluate and compare the recurrence rate and complications of conjunctival autograft (CAG) combined with preoperative mitomycin C (MMC) injection versus CAG with intraoperative local MMC over the medial rectus muscle tendon in primary pterygium. Randomized prospective study. This study included 108 eyes of 108 patients with primary fleshy or growing pterygium. All patients were from rural areas and less than 50 years old. Fifty-three patients were treated with injection of 0.1 mL of 0.15 mg/mL MMC into the body of pterygium followed 1 day later by pterygium excision and CAG (group I), and 55 patients were treated with pterygium excision and local application of 0.2 mg/mL MMC for 2 min over the medial rectus tendon followed by CAG (group II). The minimum follow-up period was 18 months. Two patients from group I and one patient from group II did not complete the follow-up period and were excluded. There were no statistically significant differences between the two groups regarding age, sex, laterality, or follow-up period. Recurrence occurred in 2 eyes in group I (3.92%) and 1 eye in group II (1.85%); (P=0.52). All recurrences occurred in male patients of less than 30 years of age. No significant complications were encountered in both groups. Both preoperative MMC injection followed 1 day later by pterygium excision with CAG, and pterygium excision and intraoperative local application of MMC on the medial rectus tendon are successful in treating primary pterygium with low recurrence rate and few complications.

Postoperative pancreatic fistula is one of the most frequent and potentially life-threatening complications following pancreatic resections. Fibrin sealants are introduced to reduce postoperative pancreatic fistula by some surgeons. However, the use of fibrin sealants during pancreatic surgery is controversial. To assess the safety, effectiveness, and potential adverse effects of fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery. We searched The Cochrane Library (2015, Issue 7), MEDLINE (1946 to 26 August 2015), EMBASE (1980 to 26 August 2015), Science Citation Index Expanded (1900 to 26 August 2015), and Chinese Biomedical Literature Database (CBM) (1978 to 26 August 2015). We included all randomized controlled trials that compared fibrin sealant group (fibrin glue or fibrin sealant patch) versus control group (no fibrin sealant or placebo) in people undergoing pancreatic surgery. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We included nine trials involving 1095 participants who were randomized to the fibrin sealant group (N = 550) and the control group (N = 545) after pancreatic surgery. All of the trials were at high risk of bias. There was no evidence of differences in overall postoperative pancreatic fistula (fibrin sealant 29.6%; control 31.0%; RR 0.93, 95% CI 0.71 to 1.21; P = 0.58; nine studies; low-quality evidence), postoperative mortality (3.1% versus 2.1%; Peto OR 1.29, 95% CI 0.59 to 2.82; P = 0.53; eight studies; very low-quality evidence), overall postoperative morbidity (29.6% versus 28.9%; RR 1.04, 95% CI 0.82 to 1.32; P = 0.77; five studies), reoperation rate (8.7% versus 10.7%; RR 0.80, 95% CI 0.53 to 1.21; P = 0.29; five studies), or length of hospital stay (12.9 days versus 13.1 days; MD -0.73 days, 95% CI -2.20 to 0.74; P = 0.331; six studies) between the groups. The proportion of postoperative pancreatic fistula that was clinically significant was not mentioned in most trials. On inclusion of trials that clearly distinguished clinically significant fistulas, there was inadequate evidence to establish the effect of fibrin sealants on clinically significant postoperative pancreatic fistula (9.4% versus 13.4%; RR 0.72, 95% CI 0.42 to 1.21; P = 0.21; three studies). Quality of life and cost effectiveness were not reported in any of the trials. Based on the current available evidence, fibrin sealants do not seem to prevent postoperative pancreatic fistula in people undergoing pancreatic surgery.

BackgroundFibrin glue effectively controls air leakage in lung surgery; however, allogenic fibrin glue cannot eliminate the risks of infection and allergy despite current sterilization methods. Autologous fibrin glue (AFG) could be a good alternative, but is not commonly used worldwide because of its limited availability and lack of evidence. Herein, we report clinical outcomes of AFG in thoracic surgery.MethodsWe retrospectively analyzed patients who underwent lobectomies or segmentectomies between November 2016 and September 2017 in our institution. We used two types of AFGs. One was a partially-autologous fibrin glue (PAFG), the components of which are largely autologous but which contains allogenic thrombin. The other was a completely-autologous fibrin glue (CAFG) which has no allogenic components. PAFG was used in the first half of the study period, after which CAFG was used from March 2017 onward. Patients who did not undergo AFG generation were categorized as the non-AFG group. The perioperative outcomes of the three groups were evaluated.ResultsA total of 207 patients underwent lung surgery, including 118 lobectomies and 89 segmentectomies. Among them, 83 patients received PAFG, 94 received CAFG, and 30 received non-AFG. The mean postoperative drainage period was within a few days in each group (PAFG vs. CAFG vs. non-AFG: 3.23±3.91 vs. 3.16±4.04 vs. 3.17±4.16 days, respectively; P=0.405), and the incidence of postoperative prolonged air leakage was within an acceptable range (PAFG vs. CAFG vs. non-AFG: 13.3% vs. 12.8% vs. 16.7%, respectively; P=0.821).ConclusionsThe use of AFG is clinically feasible for patients who undergo lobectomies or segmentectomies. AFGs could be a viable alternative to conventional allogenic fibrin glues.

To compare the outcomes between mini-simple limbal epithelial transplantation (mini-SLET) and conjunctival autograft (CAG) fixation with fibrin glue after excision of pterygium. Ninety-two eyes with primary nasal pterygium were prospectively randomized into a CAG control arm and a mini-SLET study arm. Follow-up examinations were set at the first and third day, at weeks 1, 2, and 4, and at the third and sixth month after surgery. The primary outcome measure was the recurrence rate at 1, 3, and 6 months after surgery, whereas the secondary outcome measures were the intraoperative time, postoperative symptoms, and other complications. Eighty-two eyes completed the 6-month follow-up interval. Of the 42 eyes that underwent CAG, 4 (9.5%) exhibited recurrences, whereas only 1 of the 40 eyes (2.5%) treated with mini-SLET had recurrence (P = 0.358). The time taken for surgery in the study group (21.4 minutes) was greater as compared to the control group (15.1 minutes) (P < 0.001). The postoperative median symptom (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was significantly more for all symptoms on day 1 and day 3; however, on day 7, it was significantly more for pain and irritation only. Except dellen formation (1 in each group), both groups exhibited different other complications, although less in the study group. The study group exhibited a positive trend of less recurrence with reduced postoperative symptoms and other complications. More similar studies are required in future to validate the results.

To compare the outcomes of superior versus inferior conjunctival autograft (CAU) in the prevention of recurrence after performing a pterygium surgery in patients with primary pterygia. This was a prospective randomized study of 60 eyes of 60 patients with primary pterygium. All the eyes underwent pterygium excision and were assigned randomly to receive either superior (30 eyes) or inferior (30 eyes) CAU. All grafts were attached with fibrin glue. The patients were followed up on postoperative day 1, day 7, 1 month, 3 months, and 6 months. Outcome measures included rate of recurrence, mean surgical time, visual analog scale pain score, and amount of pain medication required in the first postoperative week. The mean surgical time, visual analog scale pain score, and amount of pain medication required in both groups were not statistically different. A follow-up of at least 6 months (mean 5.5 ± 1.1 months) was achieved in 49 eyes of 49 patients (24 eyes in the superior CAU group and 25 eyes in the inferior CAU group). One eye in the superior CAU group (4.2%) and 1 eye in the inferior CAU group (4.0%) developed pterygium recurrence. There was no statistically significant difference in the recurrence rates between the 2 groups. In the inferior CAU group, mild localized donor site scarring was noted in 2 patients (8.3%). Pterygium excision with superior or inferior CAU secured with fibrin glue is safe and effective. There was no significant difference in surgical time, pain, and recurrence rates of pterygium after excision with superior or inferior CAU.

To evaluate the efficacy of autologous single-donor fibrin glue after tubeless percutaneous nephrolithotomy (PCNL). Forty-three patients were planned for tubeless PCNL in a prospective cohort study and randomized in two groups with or without using fibrin glue. Randomization method was based on the computer-generated random numbers. Transfusion, urinary leakage, or major complications were found in neither of the groups. There was no difference between two groups in stone free rate (P = .53), and changes in hemoglobin (P = .61) and serum creatinine (P = .63) level. Although autologous fibrin glue did not play any significant role in improving results or decreasing complications after tubeless PCNL in our study, its use was safe and did not increase complications.

To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery. A prospective, randomized, double-blind, clinical trial on the benefits of using fibrin adhesive in place of sutures in pterygium surgery. One hundred seventy-five eyes with primary pterygium were randomized to undergo pterygium surgery with conjunctival autograft transplantation using either fibrin adhesive or sutures. One hundred thirty-seven eyes of 113 patients that were operated on by a single surgeon (V.R.) completed the 1-year follow-up. Sixty-eight eyes were operated with fibrin adhesive and 69 eyes with sutures. Patients were followed up at 1 day, 1 week, 1 month, 6 months, and 1 year after surgery. Pterygium recurrence and postoperative pain was graded by an independent observer (A.L.) masked to the method of treatment. Surgical time was measured with a stopwatch. All patients were followed up for 1 year. There were 3 recurrences (4.41%) in the fibrin adhesive group and 11 recurrences (15.9%) in the suture group. The mean duration required to complete surgery in the fibrin adhesive group was 16.93 +/- 2.85 minutes, whereas that of the suture group was 29.84 +/- 5.65 minutes, which was statistically significant (P < 0.001). The immediate postoperative pain score and week 1 postoperative pain score were significantly lower in the fibrin adhesive group (P < 0.05). No major complications were observed in either group. The use of fibrin adhesive in primary pterygium surgery with conjunctival autografts reduces the recurrence rate, surgical time, and postoperative pain when compared with sutures.

BackgroundAlthough pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare.MethodsA 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning.ResultsSystemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted.ConclusionsSINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used.

Aim: To compare the clinical efficacy of the Bare Sclera Technique combined with Mitomycin C (MMC-BS) and the Limbal Conjunctival Autograft (LCA) technique in the surgical treatment of primary pterygium. Methods: A total of 70 eyes from 50 patients were retrospectively analyzed, with 32 (45.8%) operated using the MMC-BS technique and 38 (54.2%) using the LCA technique. The duration of surgery, complication rates, and recurrence rates were compared. Results: The mean follow-up period was 14.52±5.25 months (range: 9-18 months) in the LCA group and 14.65±5.32 months (range: 9-18 months) in the MMC-BS group (p=0.94). The duration of surgery was statistically significantly shorter in the MMC-BS group (17.13±2.8 minutes) compared to the LCA group (29.4±6.2 minutes) (p &lt; 0.001). No recurrences were observed in the LCA group, whereas one eye in the MMC-BS group showed recurrence at the 3-month follow-up. There was no statistically significant difference in postoperative complications between the two groups (p &lt; 0.5). Conclusion: The results of our study suggest that both the LCA and MMC-BS are safe and effective methods for primary pterygium surgery. Additionally, the MMC-BS technique reduces operation time and patient symptoms.