Efficacy of Autologous Fibrin Glue for Primary Pterygium Surgery with Conjunctival Autograft

To evaluate the efficiency and safety of using autologous fibrin glue for attachment of a conjunctival autograft in primary pterygium surgery In this prospective interventional case series, 15 eyes from 13 patients with primary nasal pterygium were included for conjunctival autograft surgery. On the operation day, thrombin and fibrinogen were prepared from the patient’s own blood in two separate sealed tubes in the blood transfusion center. Autologous fibrin glue was applied over the bare sclera for attachment of the free conjunctival autograft to the surrounding conjunctiva and sclera. The anatomic outcomes of flap, surgical time, recurrence rate, and other complications were evaluated on days 1, 3, and 7 and at months 1, 6, and 9 and 3 year after operation. A patient’s pain was evaluated using a 5-point scale from Lim-Bon-Siong et al grading at all visits. Of the 13 patients, 76.9% were male. The mean age of the patients was 37.26±12.61 (SD) years (range 23-60). The mean follow-up period was 34.67±2.96 months (range 25-36). Three eyes (20%) developed autograft retraction that resolved completely with continued eye patching. Two eyes (13.33%) developed total graft dehiscence, and sutures were used for reattachment of the graft in its correct position. Two eyes (13.33%) developed recurrence of pterygium, one of them had already a total graft dehiscence. In 13 eyes (86.66%), the conjunctival grafts were appropriately adhered to the bed and surrounding conjunctiva without suturing in the final visit. In the first postoperative day, ocular pain was recorded as grade 1 in 11 eyes (73.3%), grade 2 in 3 eyes (20%), and grade 3 in 1 eye (6.6%). In all patients, ocular pain disappeared during the 5 days after operation, except for two patients who needed suturing for graft reattachment, in whom ocular pain continued for 2 weeks. No other complications were found during follow-up. This case series suggests that autologous fibrin glue is a safe and useful alternative method for graft fixation in pterygium surgery.