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  1. Romano V, Cruciani M, Conti L, Fontana L
    Cochrane Database Syst Rev, 2016 12 02;12:CD011308.
    PMID: 27911983 DOI: 10.1002/14651858.CD011308.pub2
    BACKGROUND: Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Currently the best surgical option in terms of recurrence is conjunctival autograft. To date the most common surgical methods of attaching conjunctival autografts to the sclera are through suturing or fibrin glue. Each method presents its own advantages and disadvantages. Sutures require considerable skill from the surgeon and can be associated with a prolonged operation time, postoperative discomfort and suture-related complications, whereas fibrin glue may give a decreased operation time, improve postoperative comfort and avoid suture-related problems.

    OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium.

    SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2016), Embase (January 1980 to October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 October 2016.

    SELECTION CRITERIA: We included randomised controlled trials (RCTs) in any setting where fibrin glue was compared with sutures to treat people with pterygium.

    DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. Our primary outcome was recurrence of pterygium defined as any re-growth of tissue from the area of excision across the limbus onto the cornea. The secondary outcomes were surgical time and complication rate. We graded the certainty of the evidence using GRADE.

    MAIN RESULTS: We included 14 RCTs conducted in Brazil, China, Egypt, India, Malaysia, New Zealand, Philippines, Saudi Arabia, Sweden and Turkey. The trials were published between 2004 and 2016, and were assessed as a mixture of unclear and low risk of bias with three studies at high risk of attrition bias. Only adults were enrolled in these studies.Using fibrin glue for the conjunctival autograft may result in less recurrence of pterygium compared with using sutures (risk ratio (RR) 0.47, 95% CI 0.27 to 0.82, 762 eyes, 12 RCTs; low-certainty evidence). If pterygium recurs after approximately 10 in every 100 surgeries with sutures, then using fibrin glue may result in approximately 5 fewer cases of recurrence in every 100 surgeries (95% CI 2 fewer to 7 fewer cases). Using fibrin glue may lead to more complications compared with sutures (RR 1.92; 95% CI 1.22 to 3.02, 11 RCTs, 673 eyes, low-certainty evidence). The most common complications reported were: graft dehiscence, graft retraction and granuloma. On average using fibrin glue may mean that surgery is quicker compared with suturing (mean difference (MD) -17.01 minutes 95% CI -20.56 to -13.46), 9 RCTs, 614 eyes, low-certainty evidence).

    AUTHORS' CONCLUSIONS: The meta-analyses, conducted on people with pterygium in a hospital or outpatient setting, show fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. There was low-certainty evidence to suggest a higher proportion of complications in the fibrin glue group.

    Matched MeSH terms: Fibrin Tissue Adhesive/adverse effects; Fibrin Tissue Adhesive/therapeutic use*
  2. Pulikkotil SJ, Nath S
    J Coll Physicians Surg Pak, 2013 Feb;23(2):164-5.
    PMID: 23374528 DOI: 02.2013/JCPSP.164165
    The trial compared wound healing clinically, histologically and morphometrically after the use of fibrin sealant and sutures for periodontal flap closure. Ten patients were selected for this split-mouth randomized controlled clinical trial. On the test site fibrin sealant (F) was applied for flap closure after periodontal flap surgery (n = 10) and on the control site sutures (S) were used (n = 10). Clinically wound healing was observed at 7, 14 and 21 days and biopsy was taken on the 8th day. At seventh day better healing was observed in fibrin sealant site. Histologically mature epithelium and connective tissue formation was seen in fibrin sealant site with increased density of fibroblasts (F = 70.45 ± 7.22; S = 42.95 ± 4.34, p < 0.001) and mature collagen fibers. The suture site had more number of inflammatory cells (S = 32.58 ± 4.29; F = 20.91 ± 4.46, p < 0.001) and more number of blood vessels (S = 11.89 ± 3.64; F = 5.74 ± 2.41, p = 0.005). Fibrin sealant can form a better alternative to sutures for periodontal flap surgery.
    Matched MeSH terms: Fibrin Tissue Adhesive/therapeutic use*
  3. Pulikkotil SJ, Nath S
    Aust Dent J, 2014 Jun;59(2):156-64.
    PMID: 24861389 DOI: 10.1111/adj.12178
    Fibrin sealant (FS) is a biologically derived tissue adhesive for securing flaps. The aim of the present randomized controlled clinical trial was to compare early wound healing by assessing interleukin-1β (IL-1β) and interleukin-8 (IL-8) levels from gingival crevicular fluid (GCF) after using FS and suture for periodontal flap closure.
    Matched MeSH terms: Fibrin Tissue Adhesive/administration & dosage*
  4. Ratnalingam V, Eu AL, Ng GL, Taharin R, John E
    Cornea, 2010 May;29(5):485-9.
    PMID: 20308876 DOI: 10.1097/ICO.0b013e3181c29696
    To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery.
    Matched MeSH terms: Fibrin Tissue Adhesive/therapeutic use*
  5. Nadarajah G, Ratnalingam VH, Mohd Isa H
    Cornea, 2017 Apr;36(4):452-456.
    PMID: 27941383 DOI: 10.1097/ICO.0000000000001106
    PURPOSE: To evaluate graft stability and recurrence rate between fibrin glue and autologous blood in pterygium conjunctival autograft surgery.

    METHODS: A prospective, randomized, single-blinded clinical trial to assess the efficacy of autologous blood in place of fibrin glue in pterygium surgery. A total of 120 eyes of 111 patients were randomized according to pterygium morphology, to undergo pterygium surgery with autografting using either autologous blood or fibrin glue. All patients were operated by a single surgeon; 58 eyes were operated using fibrin glue and 62 eyes had a conjunctival autograft with autologous blood. Patients were seen on postoperative day 1, 1 week, 1 month, 6 months, and 1 year after surgery. Graft stability and pterygium recurrence were graded by an independent observer who was masked to the method of treatment.

    RESULTS: All 120 eyes completed the 1-year follow-up. Graft loss was seen only in the autologous blood group. Of the 62 eyes in this group, a total of 15 (24.2%) grafts dislodged. Recurrence was calculated after excluding grafts that were dislodged. Of the 105 patients, there were a total of 7 recurrences, 2 (3.4%) from the fibrin adhesive method and 5 (10.6%) from the autologous blood method. This was not statistically significant (P = 0.238).

    CONCLUSIONS: Autologous blood does not exhibit similar graft stability seen with fibrin glue. Although the recurrence rate may not be significant, careful patient selection and a standard method needs to be laid out before the use of this method is widely accepted.

    Matched MeSH terms: Fibrin Tissue Adhesive/therapeutic use*
  6. Tan SH, Brand Y, Prepageran N, Waran V
    Neurol India, 2015 Sep-Oct;63(5):673-80.
    PMID: 26448224 DOI: 10.4103/0028-3886.166539
    We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative.
    Matched MeSH terms: Fibrin Tissue Adhesive
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