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Published on: December 9, 2022
Mucous membrane grafting (fibrin glue vs. suture) for lid margin pathologies in Stevens-Johnson syndrome: randomized
Neelam Pushker1, Bhavya Gorimanipalli2, Namrata Sharma2
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. pushkern@hotmail.com.
Objective:
To compare fibrin glue (with three cardinal sutures) (FG) and polygalactin suture (PS) for mucous membrane grafting (MMG) in terms of graft apposition and recurrence of lid margin keratinization (LMK) and metaplastic lashes (ML) in patients with Stevens-Johnson syndrome (SJS).
Design:
Prospective randomized comparative interventional study.
Methods:
Twenty patients diagnosed with SJS and lid margin abnormalities including LMK with or without ML were randomized to undergo either fibrin glue (FG)-assisted MMG (n = 10) or continuous 8-0 polygalactin suture (PS)-assisted MMG (n = 10). They were evaluated preoperatively and during follow-up at 1 week and 1, 2, 3, and 6 months. The parameters assessed were best-corrected visual acuity (BCVA), tear break-up time (TBUT), Schirmer-1 test, corneal and conjunctival complications, graft apposition and width (GW), LMK, ML, impression cytology, and operative time. The primary outcome measures are incidence of graft displacement and recurrence of LMK and ML.
Results:
None of the eyelids in FG group (0/40) and 1 eyelid in PS group (1/40) had graft displacement. Recurrence of LMK occurred in 7.5% of eyelids (3/40) in both the study groups. Recurrence of ML occurred in 2.5% (1/40) in FG group and 5% (2/40) in PS group. The mean operative time for MMG in FG group was 39.5 ± 2.40 min and in PS group was 56 ± 1.63 min (p = 0.001).
Conclusions:
As graft apposition with suture involves significantly longer intraoperative time, if cost is not a limiting factor then fibrin glue is a viable option for the MMG for lid margin pathologies.
Insights
Fibrin glue (FG) offers a viable alternative to polygalactin sutures (PS) for mucous membrane grafting in Stevens-Johnson syndrome (SJS) patients, demonstrating comparable graft apposition and recurrence rates with significantly reduced operative time.
Area of Science:
- Ophthalmology
- Regenerative Medicine
- Surgical Techniques
Background:
- Stevens-Johnson syndrome (SJS) can cause severe lid margin abnormalities, including keratinization and metaplastic lashes, impacting ocular surface health.
- Mucous membrane grafting (MMG) is a surgical option to restore lid margin integrity in SJS patients.
Purpose of the Study:
- To compare the efficacy of fibrin glue (FG) versus polygalactin sutures (PS) for MMG in SJS patients.
- To evaluate graft apposition and the recurrence of lid margin keratinization (LMK) and metaplastic lashes (ML).
Main Methods:
- A prospective randomized comparative interventional study involving 20 SJS patients.
- Patients were randomized to FG-assisted MMG (n=10) or PS-assisted MMG (n=10).
- Outcomes assessed included graft apposition, recurrence of LMK and ML, and operative time over a 6-month follow-up.
Main Results:
- Graft displacement occurred in 0% of FG eyelids versus 2.5% of PS eyelids.
- Recurrence of LMK was observed in 7.5% of eyelids in both groups.
- Recurrence of ML was 2.5% in the FG group and 5% in the PS group.
- Mean operative time was significantly shorter for FG (39.5 min) compared to PS (56 min) (p=0.001).
Conclusions:
- Fibrin glue provides effective graft apposition and comparable recurrence rates for LMK and ML compared to polygalactin sutures in MMG for SJS.
- FG-assisted MMG offers a significant reduction in operative time, making it a potentially preferable option when cost is not a primary concern.
