J.Talajic, K. Miszkiewicz, L. Racine, M. Harissi-Dagher The authors have no financial interest in the subject matter of

1. Fibrin Glue versus Nylon Sutures for Conjunctival Autografting J.Talajic, K. Miszkiewicz, L. Racine, M. Harissi-Dagher The authors have no financial interest in the subject matter of this poster. in Pterygium Surgery

2. BACKGROUND • Conjunctival autografting after pterygium excision is associated with very low rates of recurrence. • Disadvantages of graft suturing include: longer surgery duration (vs. bare sclera technique), potential for granuloma formation and giant papillary conjunctivitis, and patient discomfort. • Fibrin-based adhesives for the attachment of conjunctival grafts have been associated with shorter surgery duration, improved patient comfort, and fewer complications. However, the recurrence rates with the use of fibrin glue have been investigated in few studies, the results of which have been inconsistent.

3. PURPOSE • To determine the safety and efficacy of using fibrin glue (Tisseel VH, Baxter) to attach conjunctival autografts • To compare the results with the use of nylon sutures in patients undergoing primary pterygium excision

4. STUDY DESIGN A retrospective case series was conducted of 23 eyes (23 patients) who underwent primary pterygium excision with conjunctival autograft between 2007 and 2009 at CHUM Hôpital Notre Dame in Montreal, Canada. Patients with autoimmune disease, a history of previous ocular surgery or trauma, and those who received intraoperative Mitomycin C were excluded from this study.

5. METHODS Of the 23 eyes that had undergone pterygium surgery, 12 conjunctival autografts were attached using fibrin glue by residents under the observation of one surgeon, and another 12 autografts were sutured in placewith 10-0 nylon sutures by a different attending surgeon. A chartreview was conducted and patients were reexamined toevaluate differences in: • operating time • graft success (graft intact 4 weeks postoperatively) • pterygium recurrence (growth 1 mm onto cornea) • postoperative patient comfort

6. RESULTS

9. CONCLUSION This study suggests that fibrin glue attachment of conjunctival autografts in primary pterygium excision surgery is effective and safe. The fibrin group showed less discomfort and slightly shorter operating time (with residents operating the majority of time in this group) ascompared with the standard nylon suturing technique. However, the fibrin group resulted in a higher rate of recurrence. None of these differences was statistically significant. A larger study with the same surgeonperforming both surgical techniques may be beneficialin determining whether recurrence is more frequent with theuse of fibrin glue.

10. REFERENCES • Jiang J, Yang Y, Zhang M, et al. Comparison of fibrin sealant and sutures for conjunctival autograft fixation in pterygium surgery: one-year follow-up. Ophthalmologica 2008;222(2):105-11. • Karalezli A, Kucukerdonmez C, Akova YA, et al. Fibrin Glue versus Sutures for Conjunctival Autografting in Pterygium Surgery: a Prospective Comparative Study. Br J Ophthalmol 2008;92(9):1206-21. • Ozdamar Y, Mutevelli S, Han U, et al. A Comparative Study of Tissue Glue and Vicryl Suture for Closing Limbal Conjunctival Autografts and Histologic Evaluation after Pterygium Excision. Cornea 2008;27(5):552-558. • Bahar I, Weinberger D, Gaton DD, et al. Fibrin Glue versus Vicryl Sutures for Primary Conjunctival Closure in Pterygium Surgery: Long-term Results. Curr Eye Res 2007;32:399-405. • Marticorena J, Rodriguez-Ares MT, Tourino R, et al. Pterygium Surgery: Conjunctival Autograft Using Fibrin Adhesive. Cornea 2006;25:34-6.