Ultrasonic scalpel; fibrin glue; glove perforation and contamination; preoperative hemoglobin levels

AORN Journal,  July, 2005  by George Allen

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Twenty-two patients undergoing excision of primary pterygium from June to August 2001 at a university hospital in the Philippines were prospectively enrolled in the study. In the control group (n = 11 eyes) the graft was placed onto the bare sclera, and its four corners were anchored to the episclera with 10-0 nylon sutures. The sutures were removed one month postoperatively. In the study group (n = 11 eyes), a drop of fibrin glue was placed on the bare sclera, and the graft was immediately transferred to the site. In both groups, tobramycin-dexamethasone ointment was placed in all the eyes, and a pressure patch was applied for 24 hours. Operating times were measured starting from the placement of the lid retractors to their removal at the end of the procedure.

Patients were assessed on the first day after surgery and then at weeks one, two, four, and eight for visual acuity, autograft integrity, and complications. Graft success was defined as an intact graft by the fourth week after surgery. Graft failure was defined as absence of the graft by the fourth week after surgery, and recurrence was defined as any growth of conjunctiva into the cornea. Subjective symptoms of pain, foreign body sensation, tearing, and discomfort were evaluated on the first postoperative day and at weeks one, two, and four using a five-point scale where zero equaled no pain and four equaled severe pain that interfered with usual activity or sleep. Analysis of covariance and the Friedman test for K-related samples were used to analyze the differences between the two groups.

Findings. Of the 22 patients, 13 (59%) were male and nine (41%) were female with a mean age of 54 [+ or -] 20 years (range 23 to 67 years). The mean operating time was significantly shorter when fibrin glue was used compared to sutures (P < .001). The mean surgical duration was 67 [+ or -] 3.6 minutes for patients in the suture group and 27.8 [+ or -] 1 minute for patients in the fibrin glue group. All the grafts were attached successfully and were intact at the end of the follow-up period. There were no cases of pterygium recurrence at the end of the follow-up period.

Subjective symptoms of pain, foreign body sensation, tearing, and discomfort were fewer and disappeared more rapidly for patients in the fibrin glue group compared to patients in the suture group. Additionally, the intensity of these symptoms was significantly lower for patients in the fibrin glue group (P < .001) on all follow-up days.

Clinical implications. This study revealed that the use of fibrin glue is an effective and safe method for attaching conjunctival autografts during pterygium surgery. It can significantly shorten operating time and result in fewer postoperative symptoms and less discomfort. The authors point out that long-term studies are needed to determine whether the rate of pterygium recurrence is affected by the use of fibrin glue instead of suture material. Perioperative nurses should be prepared to assist in conducting these studies.