Autologous Blood for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Meta-analysis

Hossam Zein; Ammar Ismail; Mohamed Abdelmongy; Sherif Elsherif; Ahmad Hassanen; Basma Muhammad; Fathy Assaf; Ahmed Elsehili; Ahmed Negida; Shin Yamane; Mohamed M Abdel-Daim; Kazuaki Kadonosono

doi:10.2174/1381612824666181001161352

Autologous Blood for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Meta-analysis

Curr Pharm Des. 2018;24(35):4197-4204. doi: 10.2174/1381612824666181001161352.

Authors

Hossam Zein^{1

2}, Ammar Ismail^{1

3}, Mohamed Abdelmongy^{1

4}, Sherif Elsherif^{1

5

6}, Ahmad Hassanen^{1

4}, Basma Muhammad², Fathy Assaf^{1

3}, Ahmed Elsehili^{1

7}, Ahmed Negida^{1

7}, Shin Yamane⁸, Mohamed M Abdel-Daim^{8

9}, Kazuaki Kadonosono⁸

Affiliations

¹ Medical Research Group of Egypt, Cairo, Egypt.
² Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
³ Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁴ Misr University for Science and Technology, Giza, Egypt.
⁵ Kasr Al- Ainy School of Medicine, Cairo University, Cairo, Egypt.
⁶ Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
⁷ Faculty of Medicine, Zagazig University, Zagazig, Egypt.
⁸ Department of Ophthalmology and Micro- Technology, Yokohama City University, Yokohama, Japan.
⁹ Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt.

PMID: 30277146
DOI: 10.2174/1381612824666181001161352

Abstract

Objective: The study aimed to perform a systematic review and meta-analysis of randomized controlled trials comparing the efficacy and complications of autologous blood versus using fibrin glue and surgical sutures for conjunctival autograft fixation in primary pterygium surgery.

Design: Systematic review with quantitative meta-analysis.

Methods: Four authentic databases have been searched using relevant keywords. Eligible studies were obtained, and their data were extracted into an online form. Analysis was done using Review Manager for windows. Dichotomous outcomes were reported as risk ratio, while continuous data were reported as mean difference.

Results: Seven studies were included in the analysis. Most of the included studies were of moderate quality according to Cochrane Risk of Bias assessment tool. There was no difference between the three techniques in recurrence rates (Risk Ratio (RR) 0.80, 95% CI [0.45 to 1.44], p= 0.46). Graft retraction and displacement were more profound in the autologous blood group vs fibrin glue and suture groups (RR 3.22, 95% CI [1.48 to7.02], p= 0.003) and (RR 5.27, 95% CI [2.24 to 12.38], p> 0.001) respectively. In terms of operative time, fibrin glue took shorter while suturing took longer time compared to blood coagulum (Mean Difference (MD) =1.57, 95% CI [0.90, 2.25], p> 0.00001) and (MD -20.47, 95% CI [-38.05 to -2.88], p =0.02).

Conclusion: Autologous blood for conjunctival autograft fixation in primary pterygium surgery was associated with lower graft stability than fibrin glue or sutures. However, it did not account for higher recurrence rates than the fibrin glue or sutures. Patient satisfaction and postoperative symptoms are relatively better in the blood coagulum group than the other techniques. The overall quality of evidence is low. Further well designed randomized controlled trials are still needed.

Keywords: Pterygium; conjunctival autograft; fibrin glue; graft retraction; recurrence; suture-assisted autografting..

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Autografts*
Conjunctiva / abnormalities*
Conjunctiva / surgery
Conjunctiva / transplantation*
Humans
Pterygium / surgery*
Randomized Controlled Trials as Topic