Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Network Meta-Analysis of Randomized Trials

Area of Science:

• Ophthalmology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Pterygium, an ocular surface disorder, necessitates surgical excision with conjunctival autograft (CAG).
• Postoperative recurrence and complications following CAG fixation remain significant challenges.
• Comparative efficacy of various CAG fixation methods (fibrin glue, autologous blood, sutures) is not well-established.

Purpose of the Study:

• To systematically compare the effectiveness of different conjunctival autograft fixation methods in primary pterygium surgery.
• To evaluate outcomes including recurrence, graft stability, and postoperative complications.
• To provide evidence for optimizing fixation technique selection.

Main Methods:

• Systematic review and frequentist network meta-analysis of 35 randomized controlled trials (RCTs) involving 2,501 eyes.
• Included fixation methods: fibrin glue (FG), autologous blood, autologous FG (a_FG), Vicryl, nylon, and silk sutures.
• Primary outcomes: recurrence, graft failure, granuloma; Secondary outcomes: graft dehiscence, displacement, retraction.

Main Results:

• Fibrin glue (FG) significantly reduced recurrence compared to Vicryl, nylon, and autologous blood.
• Vicryl sutures demonstrated the best graft stability and lowest graft failure rates.
• Autologous blood was associated with higher risks of graft displacement and dehiscence; FG showed lower granuloma formation than silk.

Conclusions:

• Fibrin glue (FG) is superior for minimizing pterygium recurrence.
• Vicryl sutures offer the best graft stability.
• Individualized selection of CAG fixation methods is recommended based on patient factors and resources.