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.