title: Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial.
abstract: OBJECTIVE
  To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery.
  
  
  METHODS
  Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardised digital slit-lamp photographs were taken at 1 week, 1 month and 3 months postoperatively. Sutures were masked using commercially available photo-editing software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability.
  
  
  RESULTS
  34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) postoperatively. No significant difference was found for inflammation at 1 week postoperatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076 and p = 0.624, at 1 week, 1 month and 3 months, respectively). No significant difference was found in degree of postoperative SCH between the groups (p = 0.417, p = 1 and p = 1, at 1 week, 1 month and 3 months, respectively).
  
  
  CONCLUSIONS
  This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery not only are as stable as those secured with sutures, but also produce significantly less inflammation.
authors.affiliation: Department of Ophthalmology, Toronto Western Hospital, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada. sathish.srinivasan@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Srinivasan
authors.forename: M
authors.initials: M
authors.lastname: Dollin
authors.forename: P
authors.initials: P
authors.lastname: McAllum
authors.forename: Y
authors.initials: Y
authors.lastname: Berger
authors.forename: D S
authors.initials: DS
authors.lastname: Rootman
authors.forename: A R
authors.initials: AR
authors.lastname: Slomovic
mesh_terms: D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000637:transplantation*; D003231:Conjunctivitis / Q000209:etiology; D005130:Eye Hemorrhage / Q000209:etiology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011625:Pterygium / Q000601:surgery*; D016037:Single-Blind Method; D013537:Sutures / Q000009:adverse effects; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives