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Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial

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Abstract

Purpose

To describe and compare the autologous fibrin glue and traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery.

Method

A randomized clinical trial included patients who underwent pterygium surgery with conjunctival autologous graft (CAG). Using randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient’s blood components. After centrifugation, the plasma was collected and enhanced with calcium gluconate. Postoperative assessments were performed on Days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain and complications. The mean surgical time was compared. Recurrence of the pterygium was assessed 6 months postoperatively.

Results

The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had successful graft adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% maintained graft presence in the fourth week versus 100% of the patients in the suture group (p = 0.001). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no significant difference in graft retraction or the presence of granuloma, necrosis or postoperative infection.

Conclusion

Autologous fibrin glue is an affordable option for CAG fixation in particular contexts where commercial fibrin glue is unavailable, and it could offer advantages compared to sutures. A higher graft loss rate was observed and might be related to topical anesthesia, and improvements to the technique are needed.

ClinicalTrials.gov Identifier: NCT04151017. https://clinicaltrials.gov/ct2/show/NCT04151017?term=20170467&draw=1&rank=1.

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Funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript. The authors have no relevant financial or nonfinancial interests to disclose.

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Authors and Affiliations

  1. Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil

    Christine Cioba, Bárbara Gastal Borges Fortes, Mariana Thomé Cavalheiro, Marcelo Fabris, Gustavo Michel & Alexandre Marcon

  2. Hospital de Clinicas de Porto Alegre, 2350 Ramiro Barcelos, Porto Alegre, RS, 90035-903, Brazil

    Samara Bárbara Marafon & Diane Ruschel Marinho

  3. Oftalmocentro, Porto Alegre, RS, Brazil

    Samara Bárbara Marafon, Mariana Thomé Cavalheiro & Diane Ruschel Marinho

  4. Hospital São José, Criciuma, SC, Brazil

    Gabriela Maria Zambon

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Contributions

Chirstine Cioba, Samara Barbara Marafon, Gabriela Maria Zambon, Alexandre Marcon and Diane Ruschel Marinho contributed to the study's conception and design. Material preparation and data collection were performed by Christine Cioba, Barbara Gastal Borges Fortes, Marcelo Fabris and Gustavo Michel. Data analysis were performed by Christine Cioba, Samara Barbara Marafon and Diane Ruschel Marinho. The first draft of the manuscript was written by Christine Cioba, Samara Barbara Marafon and Diane Marinho and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Samara Bárbara Marafon.

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The authors declare that there are no conflicts of interests.

Ethical approval

The study was conducted in accordance with the principles of the Declaration of Helsinki 1996 version and Good Clinical Practice standards. The study protocol was approved by the ethical committee from both hospitals involved: Hospital de Clinicas de Porto Alegre and Santa Casa de Misericordia de Porto Alegre. Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1a, 2 and 3.

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Cioba, C., Marafon, S.B., Fortes, B.G.B. et al. Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial. Int Ophthalmol 43, 2371–2381 (2023). https://doi.org/10.1007/s10792-023-02635-z

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