Autologous fibrin glue versus suture for conjunctival autograft in primary pterygium: a randomized clinical trial

Purpose: To describe and compare the autologous fibrin glue versus traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery. Method: Randomized clinical trial, including patients who underwent pterygium surgery with autologous conjunctival graft. According to randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient´s blood components. Postoperative assessments were performed on days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain, and complications. Mean surgical time was compared. Recurrence of the pterygium was assessed six months postoperatively. Results: : The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had the graft successfully adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% of them had the graft present in the 4th week versus 100% of the patients in the suture group ( p = 0.001 ). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no statistical difference in graft retraction. The presence of granuloma, necrosis and postoperative infection was not different. Conclusion: Autologous fibrin glue is an available option for ACG fixation in particular contexts where fibrin glue is unavailable and it could offer advantages compared to sutures. Improvements in the autologous glue technique are necessary before widely applying it.