Fibrin glue offers alternative to sutures

Some complications also have been associated with this technique, including graft displacement and dehiscence and a higher recurrence rate of the pterygia.

Three groups of investigators recently reported their findings on the use of fibrin glue in surgery.

Sathish Srinivasan, FRCSEd, FRCOphth, and Allan Slomovic, MD, from the Toronto Western Hospital, Toronto, conducted a single-center retrospective chart review. They applied fibrin glue to conjunctival autografts during primary pterygium surgery and wanted to evaluate the safety, efficacy, and complication rate following this procedure.

"Traditionally, the autografts have been sutured in place using either absorbable or nonabsorbable sutures. Fibrin glue has been receiving increasing attention recently for attaching the autografts," he added.

The fibrin glue (Tisseel, Baxter) is comprised of two components-a sealant protein made of human plasminogen, fibrinogen and fibrinonectin, and factor XIII reconstituted in a bovine aprotinin, and a sealing component made of thrombin reconstituted in calcium chloride. The components are combined and applied to the desired area, Dr. Srinivasan explained.

"An important step is to obtain an autograft that is about 1 mm more than the size of the conjunctival defect. This extra 1 mm of tissue is tucked under the cut edge of the conjunctiva to obtain good apposition," he said. "No sutures were used in the procedure. This tucking of tissue all along the cut margins of the conjunctiva improves the stability of the graft."