Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery.
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ABSTRACT:
SUBMITTER: Romano V
PROVIDER: S-EPMC6463968 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
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Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery.
Romano Vito V Cruciani Mario M Conti Luigi L Fontana Luigi L
The Cochrane database of systematic reviews 20161202
<h4>Background</h4>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 ...[more]
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Project description:PurposeTo compare clinical parameters and the tear levels of inflammatory cytokines between pterygium surgery using sutures or fibrin glue.MethodsFifty-six patients with primary pterygium were divided into the suture group and the glue group, in which the autograft was secured with 10-0 Vicryl sutures and fibrin glue, respectively. A questionnaire, slit-lamp examination, Schirmer test, and visual acuity test were performed in all participants. Real-time quantitative PCR (q-PCR) was used to analyze the expression of genes in pterygium and healthy conjunctival tissues. Based on the qPCR results and literature reports, five inflammatory cytokines, including hepatocyte growth factor (HGF), fibroblast growth factor 2 (FGF2), transforming growth factor-β1 (TGF-β1), matrix metalloproteinase 2 (MMP2), and tumor necrosis factor-α (TNF-α), were selected, and their protein levels were measured with enzyme-linked immunosorbent assay (ELISA) in patient tears before surgery as well as at postoperative day 1, 7, and 30.ResultsThere are 28 patients in either the suture or the glue group. The average duration of surgery was 20.17 ± 3.23 min for the glue group and 32.42 ± 4.47 min for the suture group (p = 0.000). Visual acuity in both groups was improved (p = 0.002) after the surgical procedures. There were more symptoms in the suture group than in the glue group at postoperative day 7 (p = 0.002). Postoperative symptoms disappeared in both groups at 1 month after surgery. Recurrence was observed in one case in the glue group and in two cases in the suture group at the 6 month postoperative follow-up (p = 0.714). In comparison to the preoperative levels (4.33 ± 0.43 ng/ml for the suture group; 4.20 ± 0.26 ng/ml for the glue group), the levels of TNF-α in tears increased in the suture group (5.02 ± 0.49 ng/ml, p = 0.016) and decreased in the glue group (3.84 ± 0.35 ng/ml, p = 0.052) on postoperative day 1. The glue treatment induced higher HGF production (4.78 ± 1.25 ng/ml) than the suture treatment (3.04 ± 1.18 ng/ml) at postoperative day 1 (p = 0.020). Higher levels of TGF-β1 in the glue group were detected at postoperative day 1 (3.71 ± 0.18 ng/ml) and postoperative day 30 (4.50 ± 0.51 ng/ml), compared to those in the suture group, respectively (2.74 ± 0.21 ng/ml, p = 0.000 for day 1; 3.36 ± 0.96 ng/ml, p = 0.017 for postoperative day 30).ConclusionsFibrin glue is effective and safe for attaching conjunctival autografts with an easy surgical procedure, shortened operating time, and less postoperative discomfort. In the early postoperative period, the protein expression of inflammatory cytokines implicates that fibrin glue may induce accelerated healing and subdued inflammation on the ocular surface compared to sutures.
| S-EPMC5400501 | biostudies-literature
Project description:IntroductionPterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery.Methods and analysesThis will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days.Ethics and disseminationThe trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications.Trial registration numberNCT03321201; Pre-results.
| S-EPMC6020953 | biostudies-literature
Project description: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.
| S-EPMC5522296 | biostudies-literature
Project description:BackgroundThe aim of this systematic review was to assess the effectiveness of fibrin sealant compared to sutures in periodontal surgery.MethodsFive electronic databases (PubMed, Scopus, EBSCO, Cochrane and Web of Science) were screened from initiation to January 2021 for randomized controlled trials (RCTs) comparing fibrin sealant to sutures in periodontal surgery using this search equation: (Periodont* OR Periodontitis) AND ("fibrin tissue adhesive" OR "fibrin glue" OR "fibrin sealant" OR "fibrin sealant system" OR "fibrin adhesive system" OR "fibrin fibronectin sealant system"). Quality assessment of the included studies was performed using the revised tool to assess risk of bias in randomized trials (RoB 2). The level of evidence was evaluated using the GRADE tool.ResultsA total of 240 publications were found as search results in the screened databases. Four RCTs were included in this systematic review based on predetermined inclusion criteria. The trials were published between 1987 and 2014. All the RCTs compared fibrin sealant to sutures in periodontal surgery. The sample size included 101 patients. The overall risk of bias in this systematic review was at high risk in 75% of the studies, while 25% of the studies raised some concerns. The level of evidence evaluated using GRADE tool was very low.DiscussionThe current systematic review indicates a low level of evidence of the use of fibrin sealant as an alternative to sutures in periodontal practice. More interventional and multicentric studies should be conducted to support and confirm the results of the included studies.
| S-EPMC9052248 | biostudies-literature
Project description:ObjectivesTo evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium.Materials and methodsThis prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence.ResultsIn the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard.ConclusionOlogen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.
| S-EPMC7815381 | biostudies-literature
Project description:PurposeTo evaluate the efficiency of pterygium excision with the vertical split conjunctival technique using fibrin glue in treatment of primary double-headed pterygia.Patients and methods15 eyes of 15 patients with primary double-headed pterygia that underwent vertical split conjunctival autograft pterygium surgery were retrospectively reviewed. Recurrence was defined as fibrovascular proliferation over the limbus onto the cornea.ResultsThe patients' mean age was 36.92 ± 10.8 years. At 12-month follow-up, recurrence was not seen in any cases. Regarding postoperative cosmetic grading, grade 1 (the appearance of the operated site is not different from the normal appearance) was found in 12 eyes (80%) and grade 2 (some fine episcleral vessels in the excised area extending up to but not beyond the limbus and without fibrous tissue) was found in 3 eyes (20%). None of the cases showed conjunctival scarring or fibrosis at the conjunctival donor area. Preoperative Sim K astigmatism at the central 3 mm and BCVA were 3.05 ± 1.5 diopters (D) and 0.64 ± 0.26 logMAR, which improved significantly to 1.15 ± 0.84 D and 0.26 ± 0.18 logMAR at 12-month follow-up postoperatively, respectively.ConclusionVertical split conjunctival autograft using fibrin glue is an effective technique with good cosmetic results and low to no recurrence for primary double-headed pterygia treatment. This trial is registered with NCT03507283.
| S-EPMC6317119 | biostudies-literature
Project description:PurposeTo describe a novel use of fibrin glue in managing leaking blebs and leaking wounds following trauma or surgery.MethodsInterventional case series.ResultsWe report eight patients, including three where intra-operative or immediate post-penetrating keratoplasty recalcitrant leaks from the graft-host junction and/or openings created by the needle pass, were noted. All three had thin recipient beds in the sector of leak. This was managed by intra-cameral injection of fibrin glue in the affected quadrant. This stopped the leak and allowed the defect to heal. One patient of Descemets-stripping-endothelial-keratoplasty had leak from the surgical wound, which was also sealed with fibrin glue. Two patients with leaking glaucoma-surgery-related blebs were treated with intra-bleb injection of fibrin glue to stop the leak. One patient with a penetrating corneal injury with a metal wire had a brisk leak upon removal of the wire. This was sealed with fibrin glue. Another patient of chemical burn with spontaneous leaks was managed by glue injection in the perforations. Transient rise of intraocular pressure in one patient with a leaking bleb was the only adverse event recorded.ConclusionThis novel adaptation of the application of fibrin glue can help to deal with persistent intra-operative, post-operative and traumatic aqueous and air leaks.
| S-EPMC5811733 | biostudies-literature
Project description:Conjunctival tumors involving non-limbal locations, such as the fornix and canthus, are typically excised using a "non-touch" technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.
| S-EPMC9114583 | biostudies-literature
Project description:The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft. In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns. The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age <40 years (P?=?0.019; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.34-25.28) and the presence of postoperative complications (P?=?0.008; OR, 6.32; 95% CI, 1.62-24.58) were statistically significant in multivariate analyses using logistic regression. The use of conjunctival autografts for pterygium surgery is effective, but recurrences are observed in some cases exhibiting unique pathogenic patterns according to their origin. A complete understanding of the pathogenesis of these lesions based on their morphologic regrowth pattern will help to prevent recurrences in patients who undergo pterygium surgery.
| S-EPMC4602970 | biostudies-literature
Project description:Femtosecond laser-assisted conjunctival autografts (CAG) preparation was recently proposed. This study reports the outcomes of the first clinical trial on the use of laser to prepare CAG in pterygium surgery, and to compare the outcomes with those of manual technique. Forty eyes undergoing primary pterygium excision with laser-assisted CAG transplantation were prospectively included (L group). Two historical matched cohorts whose CAGs were prepared manually were compared (n = 78 eyes by the same experienced surgeon, M group; n = 78 eyes by trainees; TM group). We found the laser-created CAGs had only 11 μm deviation from the targeted thickness. The best-corrected visual acuity improved, and the astigmatism significantly decreased after surgery, with comparable efficacy across 3 groups. The 1-year recurrence rate was 2.5%, 3.8% and 7.7% in the L, M and TM groups, respectively (P = 0.12). There was no significant difference between the L and M groups in the complication rate (5.0% and 1.3%, respectively), surgical time (19.4 ± 5.1 and 19.1 ± 6.2 minutes, respectively), and postoperative discomfort scores (0.1 ± 0.3 and 0.2 ± 0.3, respectively), but these outcomes were significantly less favorable in the TM group. The results of this first comparative clinical trial suggest that femtosecond laser-assisted CAG preparation can be considered as an alternative technique for CAGs preparation.
| S-EPMC7021803 | biostudies-literature