Fibrin Glue Versus Sutures for Securing Conjunctival Autograft in Primary Pterygium Surgery: A Systematic Review and Meta-Analysis.

TOPIC: This systematic review and meta-analysis evaluates whether fibrin glue provides superior outcomes compared to sutures for securing conjunctival autografts in primary pterygium surgery. We focused on recurrence rates, operative time, postoperative complications, and patient discomfort.

CLINICAL RELEVANCE: Pterygium recurrence and postoperative morbidity remain significant concerns in ocular surface surgery. A growing number of surgeons are adopting fibrin glue instead of sutures to anchor conjunctival autografts, but the evidence on comparative effectiveness has evolved in recent years. This updated analysis aims to guide surgical practice with the most current data.

METHODS

We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL on 8 November 2024. We included randomized controlled trials (RCTs) comparing fibrin glue versus sutures in primary pterygium surgery. Studies were screened, selected, and data-extracted by two independent reviewers. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool. The review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024520625).

RESULTS

Twenty RCTs were included. Fibrin glue significantly reduced recurrence risk compared to sutures (pooled odds ratio: 2.46; 95% CI: 1.06-5.69; 27 P  =  .0352; I2 = 0%). Operative time was significantly shorter with fibrin glue (pooled mean difference: 15.65 29 minutes; 95% CI: 11.45-19.86; P < .005; I2 = 99.29%). Pain scores at postoperative day 1 were significantly lower with fibrin glue compared with sutures (pooled standardized mean difference: 1.32; 95% CI: -2.11 to -0.52; p < .001; I2 = 90%). Rates of graft retraction were inconsistent between the two groups, while subconjunctival hemorrhages were more common in the suture group.

CONCLUSION

Fibrin glue is associated with lower recurrence rates, reduced operative time, and less postoperative discomfort than sutures in primary pterygium surgery. However, variability in graft retraction outcomes warrants further investigation. These findings support the broader adoption of fibrin glue as a preferred technique for conjunctival autograft fixation in routine clinical practice.