Goma de fibrina versus suturas para el injerto autólogo de conjuntiva en la cirugía primaria para el pterigión
Información
- DOI:
- https://doi.org/10.1002/14651858.CD011308.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 02 diciembre 2016see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud ocular y de la visión
- Copyright:
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- Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Conception and design of study, analysis and interpretation (VR, MC, LC, LF). Drafting the review or commenting on it critically for intellectual content (VR, MC, LC, LF).
Sources of support
Internal sources
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No sources of support, Other.
External sources
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National Institute for Health Research (NIHR), UK.
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Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.
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The NIHR also funds the CEV Editorial Base in London.
The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.
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Declarations of interest
VR has no financial or commercial interest in the topic area discussed in this review.
LC has no financial or commercial interest in the topic area discussed in this review.
LF has no financial or commercial interest in the topic area discussed in this review.
MC has been an advisor/consultant for Bayer, Cephalon and ViiV Healthcare, and has received honoraria for educational lectures from Abbott, ViiV Healthcare and Novartis. These activities were not related to his work with this review.
Acknowledgements
Cochrane Eyes and Vision (CEV) created and executed the electronic searches. We thank Catey Bunce and Gianni Virgili for their comments on the protocol, Cordelia Chan and Jennifer Evans for their comments on the protocol and review and Gabriela Czanner for her comments on the review. We thank Anupa Shah, Managing Editor of CEV for her assistance throughout the editorial process.
Version history
| Published | Title | Stage | Authors | Version |
| 2016 Dec 02 | Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery | Review | Vito Romano, Mario Cruciani, Luigi Conti, Luigi Fontana | |
| 2014 Sep 17 | Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery | Protocol | Vito Romano, Mario Cruciani, Luigi Conti, Luigi Fontana | |
Differences between protocol and review
We amended the protocol to include a Summary of findings table and GRADE assessment as required by updated Cochrane standards.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Autografts;
- *Sutures;
- Conjunctiva [*transplantation];
- Fibrin Tissue Adhesive [adverse effects, *therapeutic use];
- Pterygium [prevention & control, *surgery];
- Randomized Controlled Trials as Topic;
- Recurrence;
- Secondary Prevention [*methods];
- Tissue Adhesives [adverse effects, *therapeutic use];
- Transplantation, Autologous;
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Funnel plot of comparison: 1 Fibrin glue versus suture, outcome: 1.1 Recurrence of pterygium.
Funnel plot of comparison: 1 Fibrin glue versus suture, outcome: 1.2 Occurrence of 1 or more complications.
Comparison 1 Fibrin glue versus suture, Outcome 1 Recurrence of pterygium.
Comparison 1 Fibrin glue versus suture, Outcome 2 Occurrence of 1 or more complications.
Comparison 1 Fibrin glue versus suture, Outcome 3 Operating time (minutes).
Comparison 2 Fibrin glue versus suture: excluding trials at high risk of bias, Outcome 1 Recurrence of pterygium.
Comparison 2 Fibrin glue versus suture: excluding trials at high risk of bias, Outcome 2 Occurrence of 1 or more complications.
Comparison 2 Fibrin glue versus suture: excluding trials at high risk of bias, Outcome 3 Operating time (minutes).
| Fibrin glue compared with sutures for primary pterygium | ||||||
| Patient or population: individuals with pterygium Settings: hospital or outpatients Intervention: fibrin glue Comparison: sutures | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of eyes | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Sutures | Fibrin glue | |||||
| Recurrence of pterygium (follow‐up 2 to 24 months) | 100 per 1000 | 47 per 1000 | RR 0.47 (0.27 to 0.82) | 762 (12 RCTs) | ⊕⊕⊝⊝ | Large variability in duration of follow‐up |
| Occurrence of complication | 70 per 1000 | 134 per 1000 | RR 1.92 (1.22 to 3.02) | 673 (11 RCTs) | ⊕⊕⊝⊝ | |
| Operating time | The mean operating time ranged across control groups from | The mean operating time in the intervention groups was17.0 minutes less (from 20.6 minutes less to 13.5 minutes less) | 614 (9 RCTs) | ⊕⊕⊝⊝ | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Downgraded 1 level for risk of bias due to study limitations, in particular generation of allocation sequence, allocation concealment, and incomplete outcome data. | ||||||
| Complications | Fibrin glue | Suture |
| Conjunctival cyst | 2/372 | 0/439 |
| Dellen | 1/372 | 3/439 |
| Graft dehiscence | 7/372 | 2/439 |
| Graft loss | 3/372 | 0/439 |
| Graft overlying the limbus | 0/372 | 1/439 |
| Graft retraction | 7/372 | 6/439 |
| Granuloma | 4/372 | 11/439 |
| Subconjunctival haemorrhage | 3/372 | 0/439 |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Recurrence of pterygium Show forest plot | 12 | 762 | Risk Ratio (M‐H, Random, 95% CI) | 0.47 [0.27, 0.82] |
| 2 Occurrence of 1 or more complications Show forest plot | 11 | 673 | Risk Ratio (M‐H, Random, 95% CI) | 1.92 [1.22, 3.02] |
| 3 Operating time (minutes) Show forest plot | 9 | 614 | Mean Difference (IV, Random, 95% CI) | ‐17.01 [‐20.56, ‐13.46] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Recurrence of pterygium Show forest plot | 10 | 542 | Risk Ratio (M‐H, Random, 95% CI) | 0.54 [0.27, 1.08] |
| 2 Occurrence of 1 or more complications Show forest plot | 9 | 489 | Risk Ratio (M‐H, Random, 95% CI) | 2.16 [1.32, 3.51] |
| 3 Operating time (minutes) Show forest plot | 6 | 372 | Mean Difference (IV, Random, 95% CI) | ‐15.59 [‐19.90, ‐11.28] |
