Fibrin glue versus vicryl sutures for primary conjunctival closure in pterygium surgery: long-term results

PURPOSE: To compare the long-term results of conjunctival closure with fibrin adhesive or Vicryl sutures in pterygium surgery. METHODS: The study was performed in 81 patients (81 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative administration of mitomycin C 0.02%. Patients were randomized to undergo conjunctival closure with a fibrin adhesive (Quixil) (n = 42) or Vicryl sutures (n = 39). Clinical assessment was performed on postoperative days 1, 3, 10, and 21 and thereafter at 3, 6, and 12 months. All patients completed a questionnaire at each follow-up visit grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, overall satisfaction, and recurrence rate. RESULTS: Average operative time was 16 min in the fibrin-glue group and 28 minutes in the Vicryl-suture group (p < 0.05). Significantly less pain and discomfort were noted in the subjects treated with glue than in controls (p < 0.05). Satisfaction was significantly higher in the study group (p < 0.04). There were no complications during follow-up period in the glue-treated patients; one patient in the suture group had a medically treatable corneal dellen. At the end of follow-up, recurrent pterygium developed in five (11.9%) eyes of the fibrin-glue group and in three (7.7%) eyes of the Vicryl-suture group (p < 0.05). CONCLUSIONS: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient pain compared with suturing. However, it may be associated with a higher recurrence rate.     

Cut and paste: a no suture, small incision approach to pterygium surgery

AIM: Evaluation of the benefits of a new technique for pterygium surgery with respect to postoperative pain and surgery time. METHODS: A prospective randomised clinical trial was carried out in 43 patients. 43 eyes were operated for primary nasal pterygium. Autologous conjunctival graft taken at the superotemporal limbus was used to cover the sclera after pterygium excision. After randomisation, in 20 patients the transplant was attached to the sclera with a fibrin tissue adhesive (Tisseel Duo Quick) and in 23 patients with absorbable sutures (7-0 Vicryl Rapid). The Mann-Whitney test was used as statistical analysis. Postoperative pain was graded according to the visual analogue scale (VAS) twice daily during the first week after surgery. Surgery time was noted from the first incision until the lid speculum was removed. RESULTS: The average pain was significantly lower when glue had been used, p<0.05. Average surgery time was 9.7 minutes (range 6-13) for glue and 18.5 minutes (range 12-30) for sutures, p<0.001. No complications occurred. CONCLUSION: Using glue instead of sutures when attaching the conjunctival transplant in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.     

Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts

Purpose:  To compare pterygium excision conjunctival autograft surgery using Tisseel fibrin glue versus Vicryl sutures.
Method:  Prospective randomized clinical trial. Fifty patients were randomized into either sutured graft or glued graft groups. Twenty-five received standard conjunctival autograft sutured with Vicryl and 25 received surgery with the autograft placed with Tisseel fibrin glue. Outcome measures include surgical time, patient discomfort, pathology, complications and recurrence rates at 3, 6 and 12 months. Patients were followed up at days 1, 7, 14, 30, 90, 180 and 365.
Results:  The mean surgical time for the glue group was significantly shorter at 12 min compared with the suture group at 26 min ( P  < 0.001). Postoperative pain was significantly less at day 1 ( P  < 0.001) and day 2 ( P  < 0.05) but was not significantly different following these visits. Complications in the glue group included one patient with an absent graft at week 1 that required revision of the graft. At 3 months there were no recurrences in the glue group and two recurrences in the suture group. The 6- and 12-month recurrence rate was unchanged and not significantly different between the glue and suture groups (both 0/24 and 2/23, respectively).
Conclusion:  Both glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. The glued autograft recurrence rate at 12 months was similar to that of sutured grafts. Conjunctival autograft with fibrin glue in pterygium surgery decreased surgical time and resulted in less postoperative pain in the first 48 hours but had a higher complication rate.     

纤维蛋白胶在翼状胬肉切除联合无缝线羊膜移植术中应用的临床观察

目的 观察与探讨纤维蛋白胶在翼状胬肉切除联合羊膜移植术中应用的方式方法和临床效果.方法 筛选原发性翼状胬肉患者21人(26只眼),行胬肉切除联合羊膜移植术.所有患者随机分为无缝线组及缝线组:无缝线组11人(13只眼),术中将胬肉组织切除后,采用纤维蛋白胶黏合固定羊膜植片;缝线组10人(13只眼),以10-0尼龙缝线间断缝合固定羊膜植片.术后随访6个月,记录手术时间、术后症状和体征.并应用SPSS统计软件对两组结果进行分析.结果 无缝线组手术时间(13.6±3.5)min明显短于缝线组(22.3±5.2)rain(P<0.01).术后2周内(拆线前),无缝线组术眼疼痛、异物感和流泪等局部刺激症状均显著轻于缝线组(P<0.01).两组术后均未发生植片移位并发症.无缝线组术后羊膜植片贴附紧密,均于术后1周内迅速上皮化.缝线组术后有5只眼(38.5%)发生羊膜下积液,羊膜上皮化较无缝线组略迟,于术后8～ 10d完全上皮化.无缝线组羊膜愈合良好,局部无明显瘢痕发生;缝线组均出现不同程度的缝线刺激性瘢痕.术后6个月随访期内两组均未见胬肉复发.结论 在翼状胬肉切除联合羊膜移植术中使用纤维蛋白胶可替代手术缝线,使用方便,并明显缩短手术时间,减轻术后刺激症状,并利于羊膜愈合、减轻局部瘢痕,达到更好的美容目的 .     

Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft

AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.     

纤维蛋白胶和缝线固定两种方法在翼状胬肉手术中的比较

目的:在翼状胬肉切除联合自体角膜缘移植手术中,比较运用纤维蛋白胶和缝线固定两种方法的手术安全性和有效性。方法:采用前瞻性的研究。随机选取58例因鼻侧初发性翼状胬肉而进行手术的58只患眼。翼状胬肉切除后取位于颞上侧角膜缘处的自体结膜移植片以覆盖巩膜创口。58例眼分为两组,每组29例。翼状胬肉切除后,组1用纤维蛋白胶(Beriplast P)固定结膜,而组2采用8-0缝线固定结膜。术后观察患者≥6mo,对术后患者的不适感(疼痛、刺痛感、流泪)和显微镜下的检查(充血、水肿)进行评分,采用Mann-Whitney U法对两组间的差异进行统计学分析。结果:组1中有1例患者出现球结膜下出血,组2中有7例由于肉芽肿反应,于术后15d移除缝线。组1中患者的不适症状和显微镜下所见显著性优于组2。组1中有1例患者术后胬肉复发,组2中有2例复发。组1与组2比较,平均手术费用较高但手术时间明显缩短,且差异具有统计学意义(P<0.05)。结论:翼状胬肉切除后,运用纤维蛋白胶固定植片能显著地减少患者术后的疼痛,并有效地缩短手术时间。     

Pterygium surgery: conjunctival autograft using a fibrin adhesive

PURPOSE: To evaluate the efficiency and safety of using a fibrin adhesive (Tissucol Duo, Baxter AG, Vienna, Austria) to avoid the need for sutures during conjunctival autograft surgery for primary pterygium. METHODS: Twenty patients (20 eyes) with primary nasal pterygium were subjected to conjunctival autograft surgery. The free conjunctival graft placed over the bare sclera was fixed to the surrounding conjunctiva and cornea using the fibrin glue. An occlusive patch was applied. The outcome of surgery and any possible complications were periodically assessed. RESULTS: Mean patient age was 54.9 years (28-75 years). The mean follow-up time was 26.05 +/- 3.15 (SD) weeks. The time of surgery was 15 to 20 minutes. During the postoperative course, none of the patients felt pain, and only 5/20 (25%) had the mild sensation of the presence of a foreign body. In 18/20 (90%) patients, the conjunctival autograft was observed to be correctly positioned and fixed in all the follow-up exams. No sutures were used during or after surgery. There were no cases of regrowth of the pterygium. CONCLUSION: Our findings demonstrate the safety and efficiency of Tissucol Duo as a conjunctival adhesive for pterygium autograft surgery as treatment of primary pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery. Its use also avoids complications derived from sutures and diminishes the sensation of a foreign body in the eye following surgery.     

Complications of fibrin glue in pterygium surgery with amniotic membrane transplant

 Purpose:   To compare the complications and the recurrence rate between fibrin glue (TISSEEL) and Vicryl 8-0 sutures in amniotic membrane transplant during pterygium surgery. Methods: Patients who underwent pterygium surgery with amniotic membrane transplant (AMT) in the Wang Eye Clinic (Doraville, USA) were randomly categorized into two groups: one group received TISSEEL and the other group received Vicryl 8-0 sutures. All procedures for both groups were performed by one ophthalmologist. Twenty-four patients (24 eyes) participated in the TISSEEL group (22 eyes with primary surgery and 2 eyes with surgery for recurrence) and 19 patients (19 eyes) took part in the suture group (18 primary eyes and 1 recurrence). The patients with recurrent pterygium in both groups had not received AMT previously. Post-operatively, patients were followed up for one week and then one year to check for any signs of complications and recurrence. Results: Conjunctival inflammation occurred in 3 eyes (12.5%) in the TISSEEL group, and 6 eyes (31.6%) in the suture group (P<0.05, Chi-square test).  In the TISSEEL group, 1 eye (4.2%) showed recurrence, while there were no recurrences in the sutures group. There were 3 dry eyes (15.8%) in the suture group and 2 dry eyes (8.3%) in the TISSEEL group (P>0.05). No dislocated conjunctival grafts, Dellen, inflammation, infection, bleeding, pyogenic granuloma, or scleromalacia was observed in either group. Conclusion: Pterygium surgery with AMT had less conjunctival inflammation and dry eye in patients receiving fibrin glue than those with Vicryl 8-0 sutures.     

纤维蛋白胶联合绷带型角膜接触镜在复发性翼状胬肉手术中应用

目的探讨纤维蛋白胶联合绷带型角膜接触镜应用于复发性翼状胬肉手术的临床效果。方法对2013～2015年期间我院复发性翼状胬肉60例（63只眼）行翼状胬肉切除联合带自体角膜缘干细胞的结膜移植术,随机分为试验组（ A）应用纤维蛋白胶联合绷带型角膜接触镜、对照组（ B）应用缝线法联合绷带型角膜接触镜,观察手术时间、术后眼部症状、愈合、复发率、不良反应,评价其临床疗效。结果2组间比较手术时间、术后眼部症状、愈合、复发率及不良反应A组均优于B组。结论对于复发性翼状胬肉,应用纤维蛋白胶联合绷带型角膜接触镜手术时间、术后症状、愈合、复发率、不良反应更优,具有广泛的临床实用价值。     

纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的应用研究

目的探讨纤维蛋白胶固定球结膜移植片的效果和安全性。方法采用前瞻性随机对照的方法。对40例原发忡鼻侧翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术,术中分别采用纤维蛋白胶（20例,20眼）和10-0尼龙缝线（20例,20眼）同定球结膜移植片,术后随访6个月。．结果两组手术移植的球结膜瓣均成功固定于巩膜表面,并全部成活。纤维蛋门胶组患者平均手术时间（20．5±3．6）rain,104）尼龙缝线组平均手术时问（42．8±4．5）min（P〈0．01）。术后纤维蛋白胶组患者疼痛、异物感、畏光、流泪症状比缝线组轻并消失较快（P〈0．01）。随访期间两组均无复发。结论翼状胬肉切除后使用纤维蛋白胶牯贴同定自体球结膜瓣是一种安全、有效的方法。     

A Comparative Study of the Effect of Fibrin Glue versus Sutures on Clinical Outcome in Patients Undergoing Pterygium Excision and Conjunctival Autografts

Purpose

To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting.

Methods

We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting.

Results

The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups.

Conclusions

The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.     

人纤维蛋白胶在翼状胬肉切除联合新鲜羊膜移植术中的应用

目的：观察翼状胬切除联合新鲜羊膜移植术中应用人纤维蛋白胶的临床效果。

方法：采用前瞻性对照病例研究,观察2018-03/10在我院接受翼状胬肉切除联合新鲜羊膜移植术的原发性翼状胬肉患者153例153眼(双眼患者只选择胬肉较大眼手术)。将患者随机分为试验组和对照组,试验组(人纤维蛋白胶组)78例78眼,对照组(缝线组)75例75眼。在切除胬肉组织后,试验组用人纤维蛋白胶固定羊膜植片,对照组用10-0尼龙缝线间断缝合固定羊膜植片,10d后拆线。记录患者具体手术时间,比较各组患者术后2h,1、3、5及10d(拆线前)的疼痛情况,并观察术后1a时复发率情况。

结果：试验组手术时间(14.5±3.6min)短于对照组手术时间(18.3±4.2min)(P<0.05); 两组患者术后2h,1、3、5及10d(拆线前)疼痛水平评分组间、时间、时间及组间有差异(F=39.939、419.026、28.410,均P<0.01)。各时间点试验组患者疼痛水平评分均低于对照组(P<0.05); 各组内不同时间点的疼痛评分差异显著(P<0.01)。术后1a时两组患者复发率相近(P>0.05)。

结论：在翼状胬肉切除联合新鲜羊膜移植术中使用人纤维蛋白胶,可以缩短手术时间,减轻术后疼痛,但不能明显降低胬肉术后的复发率。     

纤维蛋白胶运用于翼状胬肉手术的临床观察

目的:观察纤维蛋白胶运用于翼状胬肉切除联合自体结膜移植术的临床效果。方法:选取60例60眼原发性鼻侧翼状胬肉患者随机分为试验组(纤维蛋白胶组)和对照组(缝线组)各30例30眼。行翼状胬肉切除联合自体结膜移植术,试验组采用纤维蛋白胶粘合固定植片,对照组采用10-0尼龙线缝合固定植片。术后随访6mo,观察手术时间、术后疼痛、异物感、并发症以及复发。结果:试验组手术时间(24.5±6.5min)较对照组(35.2±5.4min)短,两组差异有统计学意义(P<0.05)。术后患者疼痛和异物感试验组较对照组减轻(P<0.05)。两组均未发生术后严重并发症,试验组结膜下出血发生率低于控制组(P<0.05),6mo时纤维蛋白胶组1例(3%)复发,缝线组3例(10%)复发。结论:纤维蛋白胶运用于翼状胬肉手术固定结膜植片能减轻患者术后不适,减少手术时间及术后并发症,是一种安全有效的方法。     

纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的临床效果

目的:探讨应用纤维蛋白胶在胬肉切除联合自体角膜缘干细胞移植术中的效果。方法:对48例60眼行胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组(纤维蛋白胶组)22例30眼和对照组(缝线组)26例30眼。实验组及对照组给予常规20g/L利多卡因浸润麻醉后进行胬肉切除联合自体角膜缘干细胞移植术;试验组采用黏合剂将植片与植床进行粘贴(黏合剂为凝血酶溶液及含有因子Ⅷ和抑肽酶的纤维蛋白溶液),对照组采用10-0缝线缝合植片与植床。术后随访6mo,主要观察手术时间,植床与植片的匹配程度及术中与术后患者的疼痛评分。结果:试验组手术时间相对较短,差异有统计学意义(P<0.01),试验组植床与植片匹配度与对照组无明显差异(P<0.05),术后1wk内患者生活质量试验组优于对照组。结论:纤维蛋白胶黏合剂完全能满足胬肉切除联合自体角膜缘干细胞移植术的要求,且能清晰地切除病变组织并使植床与植片很好匹配,缩短了手术时间,减少了患者的痛苦。     

The cut-and-paste method for primary pterygium surgery: long-term follow-up

OBJECTIVE: To evaluate the recurrence rate, reoperation rate and side-effects of a novel technique for pterygium surgery. DESIGN: Retrospective study. PARTICIPANTS: The study included 461 eyes of 381 patients operated for primary nasal pterygium by the same surgeon between 1994 and 2003 and followed for 23 +/- 20 months (range 6-112 months). METHODS: Autologous conjunctival grafts harvested at the superotemporal limbus were used to cover the sclera after pterygium excision. Using a retrospective chart review, the outcome after attaching the transplant to the sclera with a fibrin tissue adhesive (n = 325) was compared to the outcome after graft attachment using absorbable sutures (n = 136). MAIN OUTCOME MEASURES: Recurrence rate, reoperation rate and complications. Results: The recurrence rate was 5.3% in the glue group and 13.5% in the suture group (p = 0.01). The reoperation rates were 1.2% and 3.3%, respectively (p = 0.31). Complications, such as transient transplant oedema and persistent corneal epithelial defects, occurred equally in both groups. CONCLUSION: Using a fibrin tissue adhesive instead of sutures when attaching the conjunctival transplant in primary pterygium surgery results in a significantly lower recurrence rate.     

纤维蛋白胶联合绷带型角膜接触镜在翼状胬肉切除术中的应用

目的：探讨应用纤维蛋白胶联合绷带型角膜接触镜减轻翼状胬肉切除联合自体角膜缘干细胞移植术后疼痛的效果。 方法：对52例72眼行翼状胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组（纤维蛋白胶联合绷带型角膜接触镜组）28例38眼和对照组（缝线组）24例34眼。试验组及对照组给予常规20 g/L利多卡因浸润麻醉后进行翼状胬肉切除联合自体角膜缘干细胞移植术。试验组采用黏合剂将植片与植床进行粘贴,对照组采用10-0缝线缝合植片与植床。术毕,试验组角膜表面放置角膜接触镜,对照组不配戴角膜接触镜。主要术后观察患者的术后1,2,3,5,7 d疼痛评分。术后随访6mo,观察植床与植片的匹配程度及感染、复发、植片愈合不良、结膜下囊肿等并发症情况。 结果：试验组患者疼痛程度评分均较对照组显著降低（均为P=0.000）。观察期内,两组植床与植片均成功固定于巩膜表面,并全部成活,同时两组患者均未发生感染、复发、植片愈合不良、结膜下囊肿等并发症。 结论：联合运用纤维蛋白胶黏合剂粘及角膜接触镜,可明显减轻翼状胬肉术后的疼痛反应。     

Comparison of fibrin glue and sutures for conjunctival wound closure in strabismus surgery

Purpose

To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery.

Methods

In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated.

Results

One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed.

Conclusions

Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.     

改良纤维蛋白粘合剂在眼表翼状胬肉手术中的应用

目的:观察表皮生长因子(epidermal growth factor,EGF)与纤维蛋白封闭剂复合物代替常规的缝线,在眼表胬肉手术中的使用情况。方法:对60例78眼翼状胬肉患者,根据胬肉生长侵犯角膜缘的范围分成两组,A组为侵犯范围<1/2者,共28例34眼,B组为侵犯范围≥1/2者,共32例44眼,随机将以上两组每组分成两小组,即A1,A2,B1,B2组。A1,B1组使用常规缝线10-0可吸收尼龙线缝合,A2,B2组为采用表皮生长因子的改良生物粘合剂纤维蛋白粘合剂粘贴法,A组手术采用胬肉切除联合结膜瓣移植术,B组手术采用单纯切除胬肉。术后对四组的手术时间、疼痛感觉、复发率、眼表上皮愈合时间、并发症等指标进行比较分析。结果:手术时间:A1组与A2组以及B1与B2组间比较具有显著差异性(P<0.05)。疼痛评估:采用改良生物粘合剂粘贴法组患者较常规缝线组疼痛减少有显著差异性(P<0.05);术后4,6d观察角膜上皮愈合情况,粘贴法组患者较常规缝线组上皮愈合面积大,有显著差异性(P<0.05);术后6mo复发率比较采用改良生物粘合剂粘贴法组患者较常规缝线组复发率减少,但统计学无显著差异性(P>0.05)。结论:在翼状胬肉手术中,采用改良纤维蛋白封闭剂复合物代替常规的缝线,可减轻患者疼痛,减轻炎症反应,缩短手术时间,避免手术后缝线松解拆线的麻烦,提高手术质量,加快术后角膜上皮愈合,降低复发率。     

两种结膜植片缝合法对翼状胬肉手术的影响

目的:评价翼状胬肉切除联合角膜缘干细胞移植术中,结膜植片两种缝合方法临床效果的差异。方法:采用前瞻随机对照试验,将48例48眼初发翼状胬肉患者随机分为A,B两组,每组24例24眼,A组术中结膜植片采用连续锁边缝合法;B组术中结膜植片采用间断缝合法。术中记录结膜缝合时间,术后随访6mo,记录拆线所用时间及眼部刺激评分情况。结果:术中平均植片缝合时间A组为14.05±2.30min,B组为19.34±2.12min,两组差异有统计学(P<0.01)。眼部刺激情况分值在术后第3d(1.32±0.60vs1.68±0.35)和第5d(0.87±0.24vs1.26±0.68),A组得分均明显低于B组(P均<0.05)。A组拆线所用时间为9.15±3.36min,B组拆线所用时间为12.61±3.89min,两组差异有统计学意义(P<0.01)。结论:连续锁边缝合法提高了手术效率,减轻了术后的刺激症状,是一种安全高效的结膜植片缝合方法。     

Fibrinklebung der Bindehaut in der Ophthalmochirurgie

BACKGROUND: Tissue adhesives offer the attractive prospect of sutureless surgery and provide a mechanism for repairing potentially difficult surgical wounds. We examined the ability of fibrin glue--instead of sutures--to close conjunctival wounds at the end of different ophthalmic surgeries. METHODS AND PATIENTS: Between 2002 and 2003 the fibrin glue Beriplast was used in our department to close the conjunctival wound in 100 eye muscle surgeries, 10 scleral buckling procedures in retinal detachment, and 20 pars plana vitrectomies. RESULTS: No patient showed postoperative adverse or allergic reactions, bacterial infections, inflammation, or delayed healing. The healing process of the conjunctiva takes a similar time course as in suture closure, but without disturbing suture ends and knots. In children with extensive Tenon's fascia, adaptation of the conjunctiva is safer using sutures. The necessary time using fibrin glue is reduced to one-fourth of the usual 4-8 min necessary for suturing the conjunctiva. The costs for fibrin glue are the same as for Vicryl 9/0, i.e., approximately 18-20 Euros per patient. CONCLUSIONS: Fibrin glue for closing conjunctival wounds results in good adaptation, is time saving, effective, and not more expensive than a suture with a high-end needle. Especially the thin atrophic conjunctiva in adults will tear using sutures in contrast to the very fast and effective adaptation with fibrin glue. Application of fibrin glue is limited in children with extensive Tenon's fascia: in these patients a suture is superior for good adaptation of the conjunctiva.