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. 2023 Mar 9;37(2):83-89.
doi: 10.4103/sjopt.sjopt_143_22. eCollection 2023 Apr-Jun.

The use of fibrin glue in pterygium surgery with amniotic membrane transplantation: Systematic review and meta-analysis

Mohammad Karam  1 , Abdulmalik Alsaif  2 , Ahmed Aldubaikhi  3   4 , Meshaal Aljebreen  5 , Rand Alazaz  5 , Tariq Almudhaiyan  6   7 , Abdullah AlBaghli  1
Affiliations

The use of fibrin glue in pterygium surgery with amniotic membrane transplantation: Systematic review and meta-analysis

Mohammad Karam et al. Saudi J Ophthalmol. .

Abstract

Purpose: To compare the outcomes of fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation.

Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. An electronic search identified all studies comparing the outcomes of using fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation. Conjunctival inflammation, postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time were primary outcome measures. Secondary outcome measures included amniotic membrane transplant outcomes, time to recurrence, graft loss, and subconjunctival hemorrhage. Fixed and random-effects models were used for the analysis.

Results: Four studies enrolling 180 patients were identified. Conjunctival inflammation (odds ratio [OR] 0.21, P = 0.0005) demonstrated a significant difference favoring the fibrin glue group. Despite the trend favoring the use of fibrin glue, there were no significant differences in terms of postoperative pain and discomfort (OR = 0.46, P = 0.25), pterygium recurrence (OR = 0.74, P = 0.48), pyogenic granuloma (OR = 0.47, P = 0.38), and surgical time (mean difference = -17.52, P = 0.13). For secondary outcomes, fibrin glue had significantly fewer cases of graft loss compared with sutures. No statistically significant difference was found in amniotic membrane graft outcomes, time to recurrence, and subconjunctival hemorrhage.

Conclusion: Fibrin glue is comparable to the sutures used in pterygium surgery with amniotic membrane transplantation as it significantly improves conjunctival inflammation and does not increase postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time.

Keywords: Amniotic membrane transplant; Pterygium; fibrin glue; sutures.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Prisma Flow Diagram. The PRISMA diagram details the search and selection processes applied during the overview. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2
Forest Plot for Odds Ratio of Fibrin Glue versus Sutures– Conjunctival inflammation. Quantitative analysis showing a statistically significant lower conjunctival inflammation in the fibrin glue group compared with the sutures group
Figure 3
Figure 3
Forest Plot for Odds Ratio of Fibrin Glue versus Sutures – Postoperative Pain and Discomfort. Quantitative analysis showing no significant difference in postoperative pain and discomfort between the fibrin glue group and the sutures group
Figure 4
Figure 4
Forest Plot for Odds Ratio of Fibrin Glue versus Sutures – Pterygium Recurrence. Quantitative analysis showing no significant difference in the rate of pterygium recurrence between the fibrin glue group and the sutures group
Figure 5
Figure 5
Forest Plot for Odds Ratio of Fibrin Glue versus Sutures – Pyogenic Granuloma. Quantitative analysis showing no significant difference in the rate of pyogenic granuloma between the fibrin glue group and the sutures group
Figure 6
Figure 6
Forest Plot for Mean Difference of Fibrin Glue versus Sutures – Surgical Time. Quantitative analysis showing no significant difference in the surgical time between the fibrin glue group and sutures group
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