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

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

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

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.

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 place with 10-0 nylon sutures by a different attending surgeon. A chart review was conducted and patients were reexamined to evaluate differences in: operating time graft success (graft intact 4 weeks postoperatively) pterygium recurrence (growth 1 mm onto cornea) postoperative patient comfort

6 RESULTS SUMMARY DATA OF PATIENTS S/P PTERYGIUM EXCISION WITH CONJUNCTIVAL AUTOGRAFT FIBRIN GLUE NYLON SUTURES P Value Age (years) Sex (%Male) Ethnicity (% Caucasian) Eye (% OD) Surgery duration (min per pterygium) Mean F/U (months) Graft Success (%) Recurrence (%)

7 FIBRIN GLUE GROUP Patient Age (years ) SexEthnicity Eye and location Surgery duration (min) Mean F/U (months) FBS PostopRecurrence Graft Success 135MAfricanOS nasal358.2No Yes 239MAfricanOS nasal205.6PO day 1NoYes 345MHispanicOD nasal351.4No Yes 445MAsian OD nasal & temporal 259PO month 1 Yes (nasal & temp) Temp: Yes Nasal: No. 549MCaucasianOS nasal3810.4PO day 1Yes 654MBlack OD temporal No Yes 763FCaucasianOS nasal199.6No Yes 871MCaucasianOS nasal366.1NoYes 973FCaucasian OD temporal 215.2No Yes 1076MHispanicOD nasal253.5PO day1NoYes 1179FCaucasianOS nasal304.5PO day 1NoYes NYLON SUTURE GROUP 131FHispanicOS nasal2419.5PO week 1NoYes 241FCaucasianOS nasal2311.4PO week 1NoYes 344MCaucasianOD nasal3018.2PO week 1NoYes 448FCaucasianOD nasal2210PO month 1NoYes 550MHispanicOS nasal258.3PO month 1NoYes 650MCaucasianOD nasal297.1PO week 1NoYes 754FBlackOS nasal2817.2PO week 1NoYes 857FCaucasianOS nasal206.7PO week 1Yes 960MCaucasianOD nasal257.6PO week 1NoYes 1061FCaucasianOS nasal249.5PO week 1NoYes 1163MCaucasianOD nasal276No Yes 1265MCaucasianOS nasal3014PO week 1NoYes

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) as compared 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 surgeon performing both surgical techniques may be beneficial in determining whether recurrence is more frequent with the use of fibrin glue.

REFERENCES 1. 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): 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): 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): 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: Marticorena J, Rodriguez-Ares MT, Tourino R, et al. Pterygium Surgery: Conjunctival Autograft Using Fibrin Adhesive. Cornea 2006;25:34-6.