Randomized interventional trial comparing conjunctival autograft secured with Sutures versus fibrin glue in primary pterygium excision

  • Dr. Keerthivarman Rukmangathan Assistant Professor, Department of Ophthalmology, Annapoorana Medical College Hospital, Veerapandi, Salem, Tamil Nadu-636308
  • Dr. Dhivya Ramakrishnan Senior Resident, Department of Ophthalmology, Annapoorana Medical College Hospital, Veerapandi, Salem, Tamil Nadu-636308
  • Dr. Vasudarini Sundararajan Professor and Head, Department of Ophthalmology, Annapoorana Medical College Hospital, Veerapandi, Salem, Tamil Nadu-636308
  • Dr. Ranjan Chandrasekaran Consultant, Annai Eye Hospital, Ramanathapuram
  • Dr. Ramusiddharthan Ravichandran Consultant, Sri Ramana Maharishi Eye Hospital, 53 C, Somavarakula street, Tiruvannamalai. Pin 636601
  • Dr. Shankar Radhakrishnan Associate Professor, Department of Preventive Medicine, VMKVMCH, Salem, Tamil Nadu 636308, India
DOI: https://doi.org/10.17511/jooo.2018.i02.01
Keywords: fibro vascular, conjunctival, aetiology

Abstract

Background: An ideal pterygium surgery should achieve three principal

goals: a low recurrence rate, absence of complications, and satisfactory cosmesis. Natural substances, such as fibrin, have significant advantage in achieving these goals.

Aim: To compare the primary & secondary outcomes following primary pterygium excision with conjunctival auto graft using fibrin glue versus sutures.

Methodology: A prospective interventional study was conducted at Department of Ophthalmology, Annapoorana medical college& Hospital, Salem, India, for a period of one year from June 2016 to May 2017. A total of 87 patients were included in the study. They were randomized into two groups. Group I received conjunctival auto graft secured with glue and Group II received conjunctival auto graft secured with suture. Postoperatively the patients were followed for a period of 6 months for measuring the primary and secondary outcomes. 

Results: The mean rank score for graft inflammation, and patients discomfort was less in fibrin glue group when compared to suture group during the follow-up period from 15th to 90th postoperative day and the difference was found to be statistically significant, whereas the mean rank for graft stability was lower in the suture group when compared to the fibrin glue group with a statistical significant difference between the two group.

Conclusion: The use of fibrin glue removes the need for the tedious suturing process, the learning curve can be shortened, and better results may be more consistently achieved despite differences in surgical expertise.

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The age and gender wise distribution of the study subjects was shown in table 1. It is seen from the table that majority of the study subjects in both the groups are in the age group between 30 and 50 years and the mean age among both the suture group and the fibrin glue group were almost similar. Similarly the male and female distribution in both the groups also did not show a statistical significant difference (table 1). The pterygium grading was done based on Donald Tan system of grading and in our study subjects majority of the patients was in either grade II or grade III and no statistically significant difference was observed between the two groups with respect to grading of pterygium (table 2). The mean duration of surgery in suture group was found to be much longer (20.6 mins) than the fibrin glue group (12.2 mins) and the difference was found to be statistical significant (table 3). The various outcome measures which were measured during the follow up period was assessed by Man-whitney U test, in which the outcome measures were ranked and the mean rank was compared between the two groups and it is interpreted as lower the rank better the outcome. The mean rank score for graft inflammation, and patients discomfort was less in fibrin glue group when compared to suture group during the follow-up period from 15th to 90th postoperative day and the difference was found to be statistically significant, whereas the mean rank for graft stability was lower in the suture group when compared to the fibrin glue group with a statistical significant difference between the two group. During the 180th day examination no inflammation and patients discomfort was reported in both the groups whereas the graft stability score was almost similar in both the groups. Among the various complications reported donor site granuloma and suture granuloma was found to be higher in the suture group compared to the fibrin glue group and the difference was found to be statistically significant, whereas the incidence of pyogenic granuloma was found to be higher in the fibrin glue group and other complications like reverse graft had occurred only in two patients in the fibrin glue group and all these complications had occurred between 15th and 30th day of the post-operative period. Among the patients in the suture group 3 patients reported with recurrence during the 180th day of follow-up and none of the patients in the fibrin glue group had recurrence and the difference was found to be statistically significant.
Randomized interventional trial comparing conjunctival autograft secured with Sutures versus fibrin glue in primary pterygium excision
CITATION
DOI: 10.17511/jooo.2018.i02.01
Published: 2018-06-30
How to Cite
Rukmangathan, K., Ramakrishnan, D., Sundararajan, V., Chandrasekaran, R., Ravichandran, R., & Radhakrishnan, S. (2018). Randomized interventional trial comparing conjunctival autograft secured with Sutures versus fibrin glue in primary pterygium excision. Tropical Journal of Ophthalmology and Otolaryngology, 3(2), 1-7. https://doi.org/10.17511/jooo.2018.i02.01
Issue
Vol 3 No 2 (2018): Apr-Jun
Section
Original Article

Copyright (c) 2018 Author (s). Published by Siddharth Health Research and Social Welfare Society

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