Fibrin Glue versus Sutures for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review of Randomized Controlled Trials.

Dr. Sweety Kumari; Dr. Amith Kumar Pampalkar; Dr. Marru Pradeep

doi:10.51168/vw7trw33

Autori

Dr. Sweety Kumari Assistant Professor, Department of Ophthalmology, Mediciti Institute of Medical Sciences, Ghanpur, Hyderabad, Telangana, India
Dr. Amith Kumar Pampalkar Assistant Professor, Department of Ophthalmology, CMR Institute of Medical Sciences, Medchal Road, Kandlakoya, Hyderabad, Telangana, India
Dr. Marru Pradeep Comprehensive Fellow, Pushpagiri Vitreo Retina Institute, West Marredpally, Secunderabad, Hyderabad, Telangana, India

DOI:

https://doi.org/10.51168/vw7trw33

Cuvinte cheie:

pterygium, conjunctival autograft, fibrin glue, fibrin sealant, sutures, recurrence, operative time, pain, systematic review, randomized controlled trial

Rezumat

Background:

Conjunctival autografting reduces recurrence after pterygium excision, but the graft-fixation technique may influence operative time, ocular comfort, graft stability, and postoperative complications.

Objective: To systematically synthesize randomized evidence comparing fibrin glue with sutures for securing conjunctival or limbal-conjunctival autografts in primary pterygium surgery.

Methods: This systematic review used a foundational evidence search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL conducted through 8 November 2024. An updated search covering 9 November 2024 to 12 July 2026 was performed in PubMed and ClinicalTrials.gov, supplemented by reference-list screening and forward-citation searching. Two reviewers independently screened records, assessed eligibility, and extracted data. Disagreements were resolved by consensus, with third-reviewer adjudication available. Randomized controlled trials comparing commercial or autologous fibrin preparations with absorbable or non-absorbable sutures after primary pterygium excision were eligible. Published random-effects estimates were retained because complete trial-level datasets were unavailable; therefore, no new meta-analysis was conducted.

Results: The foundational search identified 878 records. After removing 488 duplicates, 390 records were screened, 53 full-text reports were assessed, and 20 randomized controlled trials were included. The updated search identified no additional eligible direct-comparison trials. Recurrence favored fibrin glue, with an odds ratio for sutures versus glue of 2.46 (95% confidence interval, 1.06–5.69; P=0.035; I²=0%). Operative time was 15.65 minutes shorter with glue, and postoperative day 1 pain was lower. Considerable heterogeneity was observed for operative time and pain outcomes. Subconjunctival hemorrhage was reported in both groups, but inconsistent definitions and assessment periods prevented quantitative synthesis.

Conclusion: This systematic review indicates that fibrin glue may reduce recurrence, shorten surgery, and improve early postoperative comfort compared with sutures. However, heterogeneity and inconsistent reporting limit certainty regarding the magnitude of benefit and complication risks.

Biografii autori

Dr. Sweety Kumari, Assistant Professor, Department of Ophthalmology, Mediciti Institute of Medical Sciences, Ghanpur, Hyderabad, Telangana, India

Assistant Professor, Department of Ophthalmology
Dr. Amith Kumar Pampalkar, Assistant Professor, Department of Ophthalmology, CMR Institute of Medical Sciences, Medchal Road, Kandlakoya, Hyderabad, Telangana, India

Assistant professor, Department of Ophthalmology
Dr. Marru Pradeep, Comprehensive Fellow, Pushpagiri Vitreo Retina Institute, West Marredpally, Secunderabad, Hyderabad, Telangana, India

Comprehensive fellow in Pushpagiri Vitreo Retina Institute

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Appendix 1. Complete search strategy for the focused update

PubMed

Database last searched: 12 July 2026. Coverage: 9 November 2024 to 12 July 2026. No language, human, age, sex, or journal filters were applied.

(("Pterygium"[Mesh] OR pterygium*[tiab]) AND ("Fibrin Tissue Adhesive"[Mesh] OR "fibrin glue"[tiab] OR "fibrin sealant"[tiab] OR "fibrin adhesive"[tiab] OR "autologous fibrin"[tiab] OR Tisseel[tiab] OR Tissucol[tiab] OR Beriplast[tiab] OR Evicel[tiab]) AND ("Sutures"[Mesh] OR sutur*[tiab] OR Vicryl[tiab] OR nylon[tiab]) AND (randomized controlled trial[pt] OR controlled clinical trial[pt] OR random*[tiab] OR randomised[tiab] OR randomized[tiab] OR trial[tiab])) AND ("2024/11/09"[Date - Publication] : "2026/07/12"[Date - Publication])

ClinicalTrials.gov

Registry last searched: 12 July 2026. Study type filter: Interventional Studies. Status: all recruitment statuses. Condition/disease: pterygium. Other terms entered separately and in combination: “fibrin glue”, “fibrin sealant”, “fibrin adhesive”, “autologous fibrin”, and “suture”. No country, age, sex, phase, funder, or result-status restriction was applied. Records were examined for a direct fibrin-versus-suture comparison with conjunctival autografting for primary pterygium.

Google Scholar forward citation search.

Website last searched: 12 July 2026. Exact-title searches were performed in quotation marks for the source meta-analysis [6] and key direct-comparison trials. The “Cited by” function was then screened for reports published or indexed after 8 November 2024. Searches were repeated using the combinations “pterygium” AND “fibrin glue” AND “suture” AND randomized, and “conjunctival autograft” AND “fibrin sealant” AND sutures. No language restriction was applied.

Reference-list checking

Reference lists of the source pairwise meta-analysis [6], the 2026 network meta-analysis [7], and all newly identified potentially relevant reports were screened manually on 12 July 2026. Titles were assessed for a direct randomized comparison of fibrin glue or an explicit fibrin preparation with sutures after primary pterygium excision and conjunctival autografting.

Foundational search transparency

The foundational review last searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL on 8 November 2024 [6]. Its exact database-specific strings and exported search files were not available to the present authors and were not re-executed. Consequently, the present manuscript reports the database names, date, restrictions, and source citation exactly as available, but does not present reconstructed strings as if they were the original executed strategies.