Huang Xiaodan, Zhu Binbin, Lin Lin, Jin Xiuming
Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2018 Nov;97(44):e13050. doi: 10.1097/MD.0000000000013050.
This study was designed to compare postoperative complications and postoperative discomfort when using glue combined with nasal margin suture fixation versus fibrin glue or sutures alone to attach conjunctival autografts among Chinese patients during pterygium excisions.We analyzed the medical records of 150 eyes of 150 patients with primary pterygium, in which the autografts were secured by 3 different methods after pterygium excision: 50 eyes were secured with fibrin glue, 50 eyes were secured with glue + nasal sutures, and 50 eyes were secured with sutures. The more than 6 months of follow-up observation data included postoperative complications (graft loss/displacement, dehiscence, proliferative granuloma, inflammation, and hemorrhage), recurrence, and postoperative discomfort. A logistic regression procedure was conducted to evaluate the relationship between graft complications and the pterygium grade.Graft loss/displacement occurred in 3 patients (6%) in the glue group. Graft dehiscence occurred in 8 patients (16%) in the glue group (P < .001), with 2 developing into proliferative granuloma, compared with none in the glue + nasal sutures group and the sutures group at the 3-month postoperative follow-up. Pterygium recurrence occurred in 1 patient (2.2%) in the glue group and 2 patients (4.4%) in the sutures group, compared with none in the glue + nasal sutures group at the 6 to 9 month postoperative follow-up (P = .315). There were fewer postoperative symptoms (pain, foreign body sensation, and tearing) at days 1 and 7 in the fibrin glue and glue + nasal sutures groups than in the sutures group (P < .01). The pterygium grade was a significant risk factor for graft complications (Odd ratio, OR: 5.98, Confidence interval, CI: 1.193-29.992, P = .03) in the glue group.The modified conjunctival autograft fixation with glue + sutures on the nasal margin resulted in more stable grafts and less graft-associated complications. There was a low level of postoperative patient discomfort in the glue + sutures group. A higher grade of pterygium led to an increased rate of complications in the glue group.
本研究旨在比较在中国患者翼状胬肉切除术中，使用胶水联合鼻缘缝合固定与单独使用纤维蛋白胶或缝线来附着自体结膜移植片时的术后并发症和术后不适情况。我们分析了150例原发性翼状胬肉患者的150只眼的病历，其中在翼状胬肉切除术后，自体移植片通过3种不同方法固定：50只眼用纤维蛋白胶固定，50只眼用胶水+鼻侧缝线固定，50只眼用缝线固定。超过6个月的随访观察数据包括术后并发症（移植片丢失/移位、裂开、增生性肉芽肿、炎症和出血）、复发以及术后不适。进行了逻辑回归分析以评估移植片并发症与翼状胬肉分级之间的关系。胶水组有3例患者（6%）发生移植片丢失/移位。胶水组有8例患者（16%）发生移植片裂开（P<0.001），其中2例发展为增生性肉芽肿，而在术后3个月随访时，胶水+鼻侧缝线组和缝线组均无此情况。在术后6至9个月随访时，胶水组有1例患者（2.2%）发生翼状胬肉复发，缝线组有2例患者（4.4%）复发，而胶水+鼻侧缝线组无复发（P=0.315）。在术后第1天和第7天，纤维蛋白胶组和胶水+鼻侧缝线组的术后症状（疼痛、异物感和流泪）比缝线组少（P<0.01）。在胶水组中，翼状胬肉分级是移植片并发症（比值比，OR：5.98，置信区间，CI：1.
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