Factors associated with visual impairment among patients attending eye care services at the eye clinic in MasakaRegional referral hospital, Uganda. A cross-sectional study.

Abstract

Background:

Conjunctival autografting lowers recurrence after pterygium excision, but the method used to secure the graft affects operating time, early ocular comfort, graft stability, and postoperative complications.

Objective:

To systematically synthesize randomized evidence comparing fibrin glue with sutures for fixation of conjunctival or limbal-conjunctival autografts in primary pterygium surgery.

Methods:

The foundational evidence set was obtained from a five-database systematic review that last searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL on 8 November 2024. An update covering 9 November 2024 to 12 July 2026 searched PubMed, ClinicalTrials.gov, reference lists, and forward citations. Two reviewers independently screened records and extracted data; disagreements were resolved by consensus, with a third reviewer available for adjudication. Randomized trials comparing commercial or autologous fibrin preparations with absorbable or non-absorbable sutures after primary pterygium excision with conjunctival autografting were eligible. Published random-effects estimates were retained because a complete independent trial-level dataset was unavailable; no new meta-analysis was performed.

Results:

The foundational search identified 878 records; 488 duplicates were removed, 390 titles and abstracts were screened, 324 records were excluded, 66 reports were sought, 13 could not be retrieved, and 53 full-text reports were assessed. Thirty-three full-text reports were excluded, and 20 randomized controlled trials were included. The update identified no additional eligible direct-comparison trials. Recurrence favored fibrin glue (odds ratio for sutures versus glue 2.46, 95% confidence interval 1.06-5.69; P=0.035; I²=0%). Operative time was 15.65 minutes shorter with glue (95% confidence interval 11.45-19.86; I²=99.29%), and postoperative day 1 pain was lower (standardized mean difference -1.32, 95% confidence interval -2.11 to -0.52; I²=90%). Subconjunctival hemorrhage was reported in both groups. Extractable binary reports showed 1/11 versus 0/11, 1/29 versus 0/29, and 0/30 versus 17/30 events for glue versus sutures, while another masked trial found no significant difference in hemorrhage grade. Because definitions and assessment times differed, no pooled hemorrhage estimate was calculated.

Conclusion:

 Fibrin glue probably reduces recurrence, markedly shortens surgery, and improves early postoperative comfort compared with sutures. The size of the time and pain benefits is uncertain because heterogeneity was high. Subconjunctival hemorrhage and graft-stability outcomes varied across trials and should be interpreted by product type, technique, timing, and clinical severity.

Registration:

No separate protocol was prepared or prospectively registered for this updated synthesis. PROSPERO record CRD42024520625 belongs to the source meta-analysis and not to the present review.