目的：比较两种大小纤维蛋白胶与无缝无胶自体球结膜瓣固定术在原发性翼状胬肉手术中的患者舒适度、移植物稳定性、移植物炎症、复发等术后并发症。

方法：本研究对2014-12/2016-08共80例翼状胬肉患者(80眼)进行前瞻性介入对比研究。研究组随机抽取并分为两组，组1接受纤维蛋白胶疗法，组2采用无缝合无胶结膜自体移植固定术。每组再将等量的受试者随机平均分为两组(组1：组A+组B，组2：组C+组D)。组A(自体移植物的大小与裸眼巩膜相同)和组B(比裸巩膜大1 mm)实施纤维蛋白胶疗法； 组C(自体移植物的大小与裸眼巩膜相同)和组D(比裸巩膜大1 mm)采用无缝线无胶结膜自体移植固定术。每一位患者都接受翼状胬肉切除术，并根据组别使用不同大小的自体球结膜瓣。

结果：组1平均年龄为43.525，组2平均年龄为42.2。男性20例，女性60例。37例患者右眼有翼状胬肉。四组间平均手术时长相似。在术后随访期间，除结膜下出血(纤维蛋白胶组在术后1wk内明显增多)外， 4组间患者的舒适度、移植物回缩、移植物炎症和移植物水肿等术后参数均相似(P<0.0001)。组2仅3例患者出现4级移植物回缩/移位。术后1wk，组A和组D各出现1例移植囊肿患者。随访6mo后，组D中2例患者复发。

结论：两种方法均安全有效，术后不适及并发症少。与纤维蛋白胶疗法相比，无缝无胶疗法更加经济且效果相当。由于该手术成本低，且具有纤维蛋白胶疗法的所有优点，无缝无胶法可被认为是治疗患者非常有效的方法。

METHODS: This was a prospective interventional comparative study conducted on 80 patients(80 eyes)with pterygium from December 2014 to August 2016. The study group was randomly selected and divided into two groups, i.e. people underwent fibrin glue was group 1, and those underwent suture less glue free methods of autograft fixation was group 2. For each group equal numbers of subjects were enrolled and further each group was divided into two more groups(groups A and B in group 1, groups C and D in group 2)by random selection. Group A(size of autograft same as bare sclera)and group B(size 1 mm larger than bare sclera)received fibrin glue technique; and group C(size of autograft same as bare sclera)and group D(size 1 mm larger than bare sclera)received suture less glue free technique of conjunctival autograft fixation. Each patient underwent pterygium excision with size of conjunctival autograft used as per the respective group. Follow up visits were scheduled at 1d, 1wk, 6wk, 6mo and 1y postoperatively.

RESULTS: Mean age of the patients in group 1(Fibrin glue group)was 43.525 years old and in group 2(suture less glue free group)was 42.2 years old. Females were 60 and males were 20. All the 37 patients had pterygium in RE. Average surgical time was similar in all the four groups. Postoperative parameters like patient comfort, graft retraction, graft inflammation and graft edema were similar in all the four groups during every postoperative follow-up visits except for subconjunctival haemorrhage which was significantly more in fibrin glue group until first postoperative week(P<0.0001). Grade 4 graft retraction/displacement was observed in only three patients from group 2. At 1wk postoperative, graft cyst was observed in two patients(one in group A and one in group D). Recurrence was observed in two patients(in group D)at 6mo follow-up.

CONCLUSION: Both methods are safe and effective for graft adhesion with less postoperative discomfort and complications. Compared to fibrin glue method, suture less and glue free method is very economical and outcome in this method is comparable to fibrin glue group. Since this procedure is cost effective and also have all the advantages of fibrin glue, suture less glue free method can be considered as very effective method in treating patients.