Comparative effect of fibrin glue versus 10/0 nylon sutures on astigmatism and recurrence following conjunctival autograft in primary pterygium
Bernadette Omouwa Aghahon, Modupe Medina Balogun, Bolanle Grace Balogun, Sedoten Dagbeyon BashorunObjectives:
Pterygium is a common ocular surface disorder characterised by fibrovascular proliferation extending onto the cornea. It is strongly associated with ultraviolet exposure and is prevalent in tropical regions. The condition often induces corneal astigmatism, leading to visual impairment. Conjunctival autograft (CAG) following excision is the current gold standard treatment. However, the optimal method of graft fixation – either sutures or fibrin glue – remains controversial.
Materials and Methods:
A prospective randomised controlled trial was conducted at Lagos State University Teaching Hospital involving 70 consenting adult participants with grade 2 or 3 primary pterygium. Participants were randomly assigned to two groups: The fibrin glue group and the 10/0 nylon suture group, with 35 participants in each group. Participants with a history of recurrent pterygium, bipolar pterygium and corneal diseases were excluded. Participants were randomised into two study groups and underwent pterygium excision with CAG secured using either fibrin glue or 10/0 nylon sutures. Participants were given Maxitrol eye drops, ointment and oral diclofenac in the immediate post-operative period. Participants were followed up at 1-day, 1-week, 1-month, 3-month and 6-month post-operation. Outcomes assessed were astigmatism, recurrence, graft and detachment. All data were compared between the two groups and analysed using IBM statistical package for the social sciences version 27 software for Windows from IBM Corp., Armonk, New York, USA.
Results:
There were changes in astigmatism in the two groups from baseline astigmatism, but the changes between fibrin glue and 10/0 nylon sutures were not statistically significant, with 1.24D in the fibrin glue and 1.05D in the 10/0 nylon suture group ( p = 0.361). Two (5.7%) participants had a recurrence in the fibrin glue and 1 (2.9%) in the suture group ( p = 0.314). Only one participant (2.9%) had graft detachment in the fibrin glue group; none had graft detachment in the suture group ( p = 0.314).
Conclusion:
This study compared the treatment of primary pterygium using CAG with fibrin glue and 10/0 nylon sutures. Although variations in astigmatism, recurrence rate and graft detachment were noted between the two groups, these differences were not statistically significant. The use of fibrin glue is a satisfactory alternative for pterygium excision with CAG.