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Dr. Min-Chien Hsiao · Ophthalmology Notes
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📑 Network meta-analysis · Terres et al. 2026 · Am J Ophthalmol · 35 RCTs 2,501 eyes
Latest Research · Pterygium · CAG

Pterygium Surgery: Recurrence vs Stability
Which Fixation Method to Choose?

A May 2026 network meta-analysis (NMA) in American Journal of Ophthalmology by Terres et al. synthesised 35 RCTs and 2,501 eyes, comparing 6 conjunctival autograft (CAG) fixation methods in pterygium surgery: fibrin glue (FG), autologous fibrin glue (a_FG), autologous blood (a_blood), Vicryl, nylon, and silk sutures. Key findings: FG offered the lowest recurrence (vs Vicryl OR 0.39, p < 0.05); Vicryl ranked best for graft failure, displacement and retraction; autologous blood is cheap and suture-free but has significantly higher displacement (OR 7.40 vs Vicryl) and dehiscence (OR 10.08); limited data for silk (54 eyes) showed more granulomas (FG vs silk OR 0.11, 0.01-0.98). No single method wins all outcomes — choice should be individualised to recurrence risk, stability needs, budget, and resources.

18 min readLast updated · 2026-11-05Dr. Hsiao →
For Taiwan NHI references: the NHI drug reimbursement rules do not contain a criteria list for pterygium surgery or eye-indication fibrin glue; pterygium excision itself has NHI payment codes (87212C primary, 87213C recurrent). This article makes no claims about other costs; please rely on your hospital's pre-service explanation.
In this article· 13 sectionsClick to collapse
  1. 11. Common clinic scenarios
  2. 22. Common patient Q&As
  3. 33. Key takeaways: 8 things you really need to know
  4. 44. Pterygium pathology and epidemiology
  5. 55. What is a network meta-analysis? How are 6 methods compared?
  6. 66. Outcome 1: Recurrence — fibrin glue is best
  7. 77. Outcome 2: Graft stability — Vicryl is best
  8. 88. Outcome 3: Granuloma — silk ranked worst
  9. 99. Individualised choice: how to discuss with your doctor
  10. 1010. Taiwan context and NHI notes
  11. 1111. Post-op red flags: when to return immediately
  12. 1212. Conclusion: individualised choice + long-term sun protection
  13. 13References
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翼狀贅肉手術固定方式 NMA 一張圖看懂：解剖、6 種方法 × 3 結果比較表、3 張行動卡 Diagram: pterygium anatomy with risk factors, 6-method × 3-outcome heatmap table, and three patient-action cards. Pterygium Surgery: 6 Fixation Methods Compared Terres et al. 2026 · NMA · 35 RCTs · 2,501 eyes ① Pterygium: conjunctiva overgrows onto the cornea ↑ Pterygium (usually nasal) Untreated → astigmatism, vision drop High-risk groups ☀ Chronic UV 🏃 Outdoor work 🌡 Heat / dryness 👴 Older age Taiwan's subtropical climate = high-risk "pterygium belt" ② 6 Fixation Methods × 3 Key Outcomes Method Prevents recurrence Graft stability Safety / SE FG (fibrin glue) ★ ○ ★ Vicryl (absorbable) ○ ★ ○ Nylon (non-absorbable) ○ ○ ○ Silk ○ ○ ✗ Autologous blood ○ ✗ ○ Autologous fibrin glue ○ ✗ ○ Legend: ★ best, ○ medium, ✗ worse FG High recurrence → FG vs Vicryl OR 0.39 Sutureless, less inflammation Higher cost, availability limits Suture Need stability → Vicryl Best for avoiding graft failure Cheap, widely stocked Higher recurrence; foreign-body feel Silk: limited evidence 54 eyes: more granulomas a_blood: cheap but unstable Only for selected low-risk cases No single best method · individualise by patient factors
Pterygium fixation methods NMA at a glance. ① Pterygium is overgrowth of conjunctiva onto the cornea; untreated → astigmatism and vision loss. High-risk groups: chronic UV, outdoor work, heat / dryness, older age — Taiwan's subtropical climate puts it in the global "pterygium belt" (global prevalence about 8-12%, higher nearer the equator). ② 6 methods × 3 outcomes comparison: fibrin glue (FG) best for recurrence (vs Vicryl OR 0.39); Vicryl ranked best for graft failure, displacement and retraction; silk worst for safety (highest granuloma); autologous blood had significantly higher displacement and dehiscence risks than Vicryl. ③ Three clinical directions: (green) high recurrence risk → consider FG; (yellow) need secure fixation → Vicryl; (red) silk: limited evidence (small sample of 54 eyes, more granulomas); autologous blood only for carefully selected low-risk patients. Source: Terres et al. 2026 AJO (35 RCTs, 2,501 eyes).

1. Common clinic scenarios

'Doctor, I've worked in fisheries for 30 years, my eyes are always red, and over recent years a white tissue has crept onto the black of my right eye and my vision is getting blurry. Online they call this «pterygium» — can it be operated on? How do I pick a method that won't recur?'

'Doctor, I had pterygium surgery five years ago with sutures. It came back within a year, now it's worse. Another doctor said you can use «glue» instead of sutures — faster recovery, less recurrence. Is that true?'

'Doctor, I've heard of a «no sutures, no glue, just your own blood» method — cheap and quick. Is that real? Is it stable?'

These three scenarios reflect the three questions most often asked about pterygium surgery: what is pterygium, how to reduce recurrence, and how the different fixation methods differ. A May 2026 network meta-analysis (NMA) by Terres et al. in American Journal of Ophthalmology synthesised 35 RCTs (2,501 eyes) and is currently the most complete comparison of the 6 main fixation methods. This article distils it in clinic-friendly language.

2. Common patient Q&As

Q1: What is pterygium? Why does it grow?
A: Pterygium is fibrovascular conjunctival overgrowth creeping from the sclera (usually nasal side) onto the cornea. It's not cancer or infection — its underlying cause is chronic UV/heat/dryness-induced ocular surface inflammation plus limbal stem cell dysfunction. You'll see a triangular pink or greyish tissue extending from conjunctiva onto cornea (most often from the nasal side; also possible temporally).
Prevalence: about 8-12% worldwide (8.22% estimated for 2023 by Shan 2026; 12% in the Rezvan 2018 meta-analysis), higher at lower latitudes (nearer the equator); Shan 2026 found the highest prevalence at 20-29.9° latitude, the band Taiwan lies in. Taiwan's subtropical climate plus outdoor occupations puts it in the global "pterygium belt."
High-risk groups: outdoor workers (fishermen, farmers, construction, military), older people (prevalence rises with age), slightly male-predominant. Long sun exposure, coastal glare, hot/dry/windy environments are key risk factors.
Q2: Do I have to operate? When is the right time?
A: Not always. Mild cases can be observed with artificial tears and anti-inflammatory drops; surgery is for moderate-severe disease. Indications:
① Vision-threatening: pterygium encroaching on the cornea toward or over the pupil, or inducing significant astigmatism.
② Cosmetic concern: socially distressing redness or thick tissue.
③ Persistent inflammation / discomfort: recurrent redness, foreign-body sensation, tearing, contact-lens intolerance despite medical care.
④ Rapid progression: significant growth within 1-2 years, threatening the central cornea.
For small, vision-stable pterygia, observation + sun protection + artificial tears is reasonable. Surgery doesn't remove the UV source, so post-op sun protection and ocular surface care must continue.
Q3: How is surgery done? What is conjunctival autograft (CAG)?
A: The current standard is "excision + conjunctival autograft (CAG)." Steps: (1) local anaesthesia; (2) careful excision of pterygium tissue including subepithelial Tenon's fibrovascular tissue; (3) the bare sclera left behind has very high recurrence (historically 24-89%); (4) so a piece of healthy conjunctiva is harvested from the same eye's superior conjunctiva and placed over the bare area; (5) this graft is then «fixed» in place — the subject of this article: fibrin glue, autologous blood, Vicryl / nylon / silk sutures, or autologous fibrin glue (6 methods).
Why CAG? Without covering with healthy tissue, fibrovascular tissue regrows quickly. A conjunctival autograft provides fresh healthy epithelium and dramatically lowers recurrence (from ~50% → under ~10%).
Q4: Does it recur after surgery? How often?
A: Yes, but with CAG and appropriate fixation, much lower than historical rates. Without grafting, recurrence was 24-89%. With CAG, fixation also matters: in the Lan 2017 meta-analysis, fibrin glue versus sutures (all suture types pooled) had a recurrence OR of 0.35 (95% CI 0.24-0.51). In Terres 2026, FG vs Vicryl recurrence OR 0.39 (95% CI 0.22-0.69, p < 0.05) — significantly lower.
Timing: most recurrences occur within the first post-op year; staying clear at 1 year suggests better long-term stability. Risk factors: the literature mentions younger patients (one study found higher risk under age 45), poorly controlled post-op inflammation, and surgical factors (incomplete excision, small graft, retained Tenon's tissue, graft retraction); continued UV exposure may also matter. Discuss your own risk with your doctor.
Q5: «Sutures» vs «glue» vs «autologous blood» — what's the difference?
A: It comes down to mechanical fixation vs biological adhesion, post-op inflammation, comfort, recurrence, and cost.

① Fibrin glue (FG): commercial biological glue (fibrinogen + thrombin), applied under the graft for instant bonding. Pros: sutureless, no foreign-body sensation, less inflammation, lowest recurrence. Cons: higher cost, requires stock, blood-derivative restrictions in some countries.
② Vicryl: synthetic absorbable suture (polyglactin), fully absorbed in about 56-70 days (8-10 weeks; manufacturer Ethicon product data). Pros: most mechanically stable, cheap, widely stocked. Cons: takes time to suture, foreign-body sensation, more inflammation, recurrence slightly higher than FG.
③ Nylon: non-absorbable, requires suture removal. Pros: durable, cheap. Cons: needs removal, more discomfort, less popular in modern pterygium surgery.
④ Silk: natural protein fibre, needs removal. Limited evidence: only small-sample data in Terres 2026 (54 eyes), showing more granulomas (FG vs silk OR 0.11, 0.01-0.98); strong inflammatory reaction.
⑤ Autologous blood (a_blood): graft is allowed to autocoagulate to the bed — no sutures, no glue. Pros: fully autologous, zero materials cost. Cons: weak fixation, significantly higher displacement/dehiscence (vs Vicryl OR 7.40 / 10.08); only for selected low-risk patients.
⑥ Autologous fibrin glue (a_FG): fibrinogen extracted from patient's own plasma. Limited evidence, variable strength; highest failure rate in this NMA (very wide CI).
Q6: Which is best? How do I discuss with my doctor?
A: No single best method — choose by individual recurrence risk, stability needs, budget, and surgeon experience. Discussion points:
• "Am I high-recurrence-risk?" (young, ongoing outdoor work, pre-op inflammation → favours FG)
• "Can I follow up reliably?" (poor compliance / can't return for suture removal → favours absorbable suture or glue)
• "Budget concerns?" (out-of-pocket differences vary; check with your facility)
• "Recurrent case?" (higher risk → FG plus possibly adjuncts like amniotic membrane)
• "Which method are you (the surgeon) most experienced with?" (surgeon experience strongly affects outcome)
Bottom line: NMA gives population-level evidence, but surgeon experience, your local hospital's resources, and your own factors are decisive.
Q7: Post-op precautions? Red flags for recurrence?
A: The three post-op essentials are sun protection, anti-inflammation, and follow-up.
• Sun protection: outdoor activity → UV400 sunglasses + wide-brim hat; especially important in Taiwan's high-UV months (late spring to autumn). UV is the strongest environmental driver of recurrence.
• Post-op drops: your doctor will prescribe topical steroid + antibiotic drops. Steroid dose/duration follows your doctor's taper — don't stop on your own. Long-term use needs IOP and lens monitoring.
• Follow-up: the schedule is set by your doctor; regular visits in the first year matter, since most recurrences occur then.
Red flags (same-day return): (1) sudden severe pain or vision loss; (2) visible graft displacement or detachment; (3) persistent redness or discharge (infection); (4) increased bare sclera; (5) new fibrovascular tissue creeping onto the cornea within 6 months.

3. Key takeaways: 8 things you really need to know

30-second takeaways

  • Largest NMA: Terres 2026 synthesised 35 RCTs and 2,501 eyes — the most complete fixation-method evidence to date
  • FG is best for recurrence: vs Vicryl OR 0.39 (significant); vs nylon 0.38 (significant); vs a_blood 0.74 (not significant)
  • Vicryl is best for graft stability: ranked first for graft failure, displacement and retraction (silk and nylon ranked better for dehiscence)
  • a_blood is cheap but unstable: displacement OR 7.40, dehiscence 10.08, retraction 20.10 (all vs Vicryl, significant)
  • Silk: limited evidence: small-sample data (54 eyes) show more granulomas (FG vs silk OR 0.11, 0.01-0.98)
  • No single best method: individualise by recurrence risk, stability needs, budget, surgeon experience
  • 3 critical post-op essentials: sun protection (UV400 sunglasses), steroid drops per doctor's taper, regular follow-up
  • Taiwan: subtropical high-prevalence region; for cost and NHI coverage details, ask your ophthalmologist and your hospital's pre-service notice

4. Pterygium pathology and epidemiology

Pterygium was historically seen as a "benign fibrovascular conjunctival overgrowth" — modern research reframes it as a limbal stem cell-associated disorder, characterised by: (1) centripetal proliferation of altered limbal epithelial cells; (2) dissolution of Bowman's layer; (3) epithelial-mesenchymal transition; (4) activation of fibrovascular stroma with inflammation, neovascularisation, and ECM remodelling.

Environmental risk factors: chronic UV, heat, geographic location (more near equator), chronic ocular surface inflammation, nutrition. Prevalence: about 8-12% worldwide (8.22% estimated for 2023 by Shan 2026; 12% in the Rezvan 2018 meta-analysis), higher at lower latitudes — the global "pterygium belt." Taiwan's subtropical climate + outdoor occupations places it in this band. Demographics: slight male predominance; prevalence rises with age (Shan 2026: about 3.5% at 20-29, 8.3% at 40-49, 14.5% at 50-59 and 18-19% from age 60).

Clinical presentation: tearing, dry eye, conjunctival hyperaemia, foreign-body sensation, induced corneal astigmatism, pseudo-dry-eye symptoms; severe cases threaten vision. Historical recurrence: bare excision 24-89% (varies by technique, Tenon excision depth, inflammation control); conjunctival autograft lowers it markedly (about 5-10% per EyeWiki).

5. What is a network meta-analysis? How are 6 methods compared?

Network meta-analysis (NMA) is an advanced evidence-synthesis method. Pairwise meta-analyses compare two methods at a time; NMA compares multiple treatments simultaneously, integrating direct evidence (A vs B) and indirect evidence (A vs C, C vs B → infer A vs B), producing pairwise effect estimates across all methods and probabilistic P-score rankings for each outcome.

Scroll horizontally to read the table. With a keyboard, focus the table area and use the arrow keys.

ItemDetail
InclusionPrimary pterygium patients; CAG; comparing at least 2 of FG/a_FG/a_blood/Vicryl/nylon/silk; RCT
ExclusionRecurrent pterygium; adjuncts (mitomycin C, amniotic membrane, radiation); unspecified suture; non-comparative designs
Scale35 RCTs, 2,501 eyes, from regions including Asia, South America, Africa and the Middle East
Primary outcomesRecurrence, graft failure, granuloma formation
Secondary outcomesGraft dehiscence, displacement, retraction
AnalysisFrequentist network meta-analysis using R, random-effects models and P-score ranking.

6. Outcome 1: Recurrence — fibrin glue is best

Recurrence is the primary efficacy endpoint, defined as "any postoperative fibrovascular tissue extending ≥1 mm from the limbus onto the cornea" (or a clinically equivalent definition used by the trial authors). NMA results: each OR below compares FG with the named comparator.

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ComparisonRecurrence OR (95% CI)
FG vs Vicryl0.39 (0.22–0.69)
FG vs Nylon0.38 (0.18–0.82)
FG vs autologous blood0.74 (0.42–1.30), not significant (see note)

Each OR compares FG with the named comparator; these are not estimates for the other methods versus Vicryl. The intervals for FG vs Vicryl and FG vs nylon exclude 1. Note: the paper's abstract and results text give FG vs autologous blood as 0.52 (0.28–0.96), significant, but in the paper's recurrence league table (Figure 3) 0.52 (0.28–0.96) is autologous blood vs nylon; the table gives autologous blood vs FG as 1.35 (0.77–2.36), i.e. FG vs autologous blood about 0.74 (0.42–1.30), not significant (consistent with 0.39 ÷ 0.52 ≈ 0.75 from the comparisons with Vicryl).

P-score recurrence ranking: FG had the highest probability of being most effective. Versus Vicryl, a_blood OR 0.52 (0.28-1.00) was borderline; nylon (1.01) and silk (1.12) did not differ significantly from Vicryl. FG vs nylon OR 0.38 (0.18-0.82), also significant; FG vs a_blood was not significant (see table note above).

Mechanism: FG's advantage stems from (1) immediate uniform bonding minimising graft micromotion and inflammatory exposure; (2) no needle penetration, no mechanical irritation; (3) stable epithelial interface promoting rapid coverage; (4) reduced post-op inflammation overall. These factors together lower fibrovascular regrowth probability. The earlier Lan 2017 meta-analysis likewise found a recurrence OR of 0.35 for FG versus sutures.

7. Outcome 2: Graft stability — Vicryl is best

Graft stability covers 4 endpoints: graft failure (a primary outcome; requiring re-suturing, repositioning or re-operation) and 3 secondary outcomes — dehiscence (separation from surrounding conjunctiva), displacement (post-op shifting), retraction (graft pulls back exposing sclera). Vicryl ranked first for graft failure, displacement and retraction (silk and nylon ranked better for dehiscence). The table below compares autologous blood with Vicryl:

Scroll horizontally to read the table. With a keyboard, focus the table area and use the arrow keys.

Outcome vs Vicryla_blood ORInterpretation
Displacement7.40 (1.91-28.68)❌ a_blood significantly 7× higher
Dehiscence10.08 (1.16-87.69)❌ a_blood significantly 10× higher
Retraction20.10 (1.59-253.75)❌ a_blood significantly higher (wide CI, interpret cautiously)
Failure2.31 (0.46-11.48)No significant difference

Mechanism: Vicryl is a synthetic absorbable suture providing moderate-tension secure mechanical fixation, fully absorbed in about 56-70 days (8-10 weeks). Unlike non-absorbable sutures (nylon, silk), no removal needed; unlike glue or autologous blood, it doesn't rely on biological adhesion. For patients with limited follow-up reliability or where secure mechanical fixation is paramount, Vicryl is the most dependable option in the network.
But Vicryl's recurrence rate is higher (significantly vs FG) — so it's a stability-vs-recurrence trade-off.

8. Outcome 3: Granuloma — silk ranked worst

Subconjunctival granuloma is a post-op local inflammatory fibrovascular mass causing persistent discomfort, cosmetic concern, and occasionally requiring excision. Terres 2026: FG vs silk granuloma OR 0.11 (0.01-0.98, significant in the direct comparison) — silk's odds of granuloma are about 9× those of FG. However, the silk data come from a small sample (54 eyes); the confidence interval is wide with an upper bound close to 1, and the network estimate combining indirect evidence in the paper's league table (Figure 9) is 0.31 (0.06-1.70), not significant, so interpret cautiously. In the granuloma ranking a_FG ranked best and silk worst; in their discussion the authors state that silk has largely fallen out of favour because of foreign-body inflammation and should not be considered an option for graft fixation.
This NMA analysed only 6 outcomes (recurrence, graft failure, granuloma, dehiscence, displacement, retraction); other complications such as foreign-body sensation, subconjunctival haemorrhage and infection were outside its scope. Clinical consensus: sutureless methods (FG, a_blood) are more comfortable than sutures (Vicryl, nylon, silk).

9. Individualised choice: how to discuss with your doctor

💡 6 questions to ask your ophthalmologist

  • 1. How severe is my pterygium? Is surgery essential? — confirm whether non-surgical options suffice (artificial tears, sun protection, anti-inflammation)
  • 2. Am I "high-recurrence-risk"? — young, continued outdoor work, severe pre-op inflammation, prior recurrence → FG should be prioritised
  • 3. Can I follow up reliably? — poor compliance / can't return for suture removal → absorbable suture (Vicryl) or glue preferred
  • 4. Which method are you (the surgeon) most experienced with? — surgeon experience strongly affects outcomes
  • 5. How are costs structured? — NHI vs out-of-pocket; FG self-pay specifics vary — check with your facility
  • 6. How do I prevent recurrence post-op? — sun protection, steroid drop schedule, follow-up intervals, recurrence red flags

10. Taiwan context and NHI notes

⚠️ Costs & coverage — always confirm with your hospital

  • Costs for pterygium surgery, fixation consumables (sutures, fibrin glue, etc.), NHI coverage vs out-of-pocket components can vary by hospital. Confirm pricing directly with your ophthalmologist and the facility before surgery, and refer to the latest NHIA announcements.
  • Post-op topical steroids and antibiotics: agent and duration are prescribed by your ophthalmologist based on your case. Under Taiwan NHI drug reimbursement rules (updated 2026-10-22), section 14.4.1, quinolone antibiotic drops (e.g. moxifloxacin, levofloxacin) are limited to corneal ulcer or severe keratitis; for other eye conditions they are second-line drugs and a bacterial sensitivity report must accompany the claim. Section 14 sets no specific coverage restriction for ordinary steroid eye drops. Discuss details with your prescriber.
  • Sunglasses / wide-brim hat: not NHI-covered, but the single most important environmental intervention to prevent recurrence — UV400 or higher recommended, with a wide-brim hat for outdoor work or prolonged sun exposure.

11. Post-op red flags: when to return immediately

🚨 Post-pterygium-surgery red flags

  • Sudden severe pain or significant visual decline
  • Visible graft displacement or detachment (graft shifted from original position)
  • Persistent redness, swelling, purulent / yellow-green discharge (suspect infection)
  • Bare sclera area enlarging (white area expanding)
  • New fibrovascular tissue creeping onto cornea within 6 months — early recurrence signal
  • Blurring, headache, nausea while on post-op steroid drops — possible steroid-induced IOP rise

If any of the above, return to your surgeon or ophthalmology ER the same day.

12. Conclusion: individualised choice + long-term sun protection

Terres et al. 2026 NMA delivers three key messages:

  • No single best method — FG best for recurrence, Vicryl best for stability; choice depends on your individual recurrence risk, compliance, budget, surgeon experience
  • Silk: limited evidence — small-sample data (54 eyes) show more granulomas (FG vs silk OR 0.11, 0.01-0.98)
  • Autologous blood only for carefully selected low-risk cases — significantly higher displacement, dehiscence, retraction (vs Vicryl OR 7-20)

The most important message for patients: surgery only removes this episode of pterygium; long-term success depends on post-op lifestyle, sun protection, and ocular surface care. Taiwan's subtropical UV is high; outdoor workers especially should make UV400 sunglasses + wide-brim hat standard. Remember: you can redo the surgery, but the sun won't stop shining.

📚 HsiaoEye Related Articles — Cornea & Conjunctiva / Ocular Surface

References

  1. Terres MT, Hira S, de Avila MF, Pereira EMM, Shamsher E, Wagner F, Ribeiro GDR, Assis MLM, Mannan A, Bertholde GD, Vilela M, Piovezan AP. Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Network Meta-Analysis of Randomized Trials. Am J Ophthalmol. 2026;285:240–253. doi:10.1016/j.ajo.2026.02.005.
  2. Lan A, Xiao F, Wang Y, Luo Z, Cao Q. Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence. Oncotarget. 2017;8(25):41487–41497.
  3. Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016;(2):CD011349.
  4. Chui J, Coroneo MT, Tat LT, Crouch R, Wakefield D, Di Girolamo N. Ophthalmic pterygium: a stem cell disorder with premalignant features. Am J Pathol. 2011;178(2):817–827.
  5. Tandon R, Vashist P, Gupta N, et al. The association of sun exposure, ultraviolet radiation effects and other risk factors for pterygium (the SURE RISK for pterygium study) in geographically diverse adult (≥40 years) rural populations of India—3rd report of the ICMR-EYE SEE study group. PLoS One. 2022;17(7):e0270065.
  6. Hirst L. Long-term results of P.E.R.F.E.C.T. for PTERYGIUM. Cornea. 2021;40(9):1141–1146.
  7. Lee BWH, Ip MH, Tat L, Chen H, Coroneo MT. Modified limbal-conjunctival autograft surgical technique: long-term results of recurrence and complications. Cornea. 2023;42(10):1320–1326.
  8. Karalezli A, Kucukerdonmez C, Akova YA, Altan-Yaycioglu R, Borazan M. Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study. Br J Ophthalmol. 2008;92(9):1206–1210.
  9. Bista D, Byanju R, Gautam MA. Sutureless glue free versus sutured limbal conjunctival autografts in primary pterygium surgery. Nepal J Ophthalmol. 2021;13(24):95–104.
  10. Cioba C, Marafon SB, Fortes BGB, et al. Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial. Int Ophthalmol. 2023;43(7):2371–2381.
  11. Koranyi G, Seregard S, Kopp ED. Cut and paste: a no suture, small incision approach to pterygium surgery. Br J Ophthalmol. 2004;88(7):911–914.
  12. Nadarajah G, Ratnalingam VH, Mohd Isa H. Autologous Blood Versus Fibrin Glue in Pterygium Excision With Conjunctival Autograft Surgery. Cornea. 2017;36(4):452–456.
  13. Rezvan F, Khabazkhoob M, Hooshmand E, Yekta A, Saatchi M, Hashemi H. Prevalence and risk factors of pterygium: a systematic review and meta-analysis. Surv Ophthalmol. 2018;63(5):719–735.
  14. Shan S, Wu J, Liu X, Zhou J, Zheng Y, Rudan I, Song P; Global Health Epidemiology Research Group (GHERG). Global, regional, and national prevalence of pterygium in 2023: a systematic review and modelling analysis. J Glob Health. 2026;16:04271.
  15. Ghiasian L, Samavat B, Hadi Y, Arbab M, Abolfathzadeh N. Recurrent pterygium: a review. J Curr Ophthalmol. 2021;33(4):367–378. doi:10.4103/joco.joco_153_20
  16. Khan N, Ahmad M, Baseer A, Kundi NK. To compare the recurrence rate of pterygium excision with bare-sclera, free conjunctival auto graft and amniotic membrane grafts. Pak J Ophthalmol. 2010;26(3).
  17. EyeWiki. Pterygium. American Academy of Ophthalmology. Accessed October 16, 2026. https://eyewiki.org/Pterygium
  18. Ethicon (Johnson & Johnson MedTech). VICRYL (polyglactin 910) Suture, product information (absorption rate 56–70 days). Accessed October 16, 2026. https://www.ethicon.com/emea/epc/code/v549g?lang=en-be

Frequently asked questions

How high is the recurrence rate after pterygium surgery, and which fixation method recurs least?
With conjunctival autograft, recurrence drops markedly, and fixation also matters: in the Lan 2017 meta-analysis, fibrin glue (FG) versus sutures had a recurrence odds ratio of 0.35. In the Terres et al. 2026 network meta-analysis, FG versus Vicryl had a recurrence odds ratio of 0.39 (statistically significant), making FG the best method for preventing recurrence.
Is fixation with glue really better than sutures?
There is no single best method. Fibrin glue gives the lowest recurrence, no suture foreign-body sensation, and less inflammation, but costs more and needs stocking; Vicryl absorbable sutures ranked best for graft failure, displacement and retraction, plus they are cheap and widely stocked, at the cost of foreign-body sensation and slightly higher recurrence. The choice should be individualised to your recurrence risk, budget and surgeon experience.
Is the «no sutures, no glue, autologous blood only» method safe and stable?
Autologous blood fixation uses your own blood with zero materials cost, but its hold is weaker. In Terres et al. 2026, versus Vicryl sutures, graft displacement had an odds ratio of 7.40 and dehiscence 10.08 — significantly higher — so it suits only carefully selected low-risk patients, not everyone. Discuss thoroughly with your ophthalmologist before choosing it.
Does pterygium always need surgery, and when is the right time?
Not necessarily. Mild cases that do not affect vision or appearance can be observed with sun protection and artificial tears. Surgery is usually considered when the pterygium encroaches on the cornea toward the pupil or induces significant astigmatism that affects vision, when appearance is distressing, when inflammation persists despite conservative care, or when it grows rapidly within one to two years threatening the central cornea. Surgery does not remove the underlying UV damage.
What are the drawbacks of silk fixation?
Silk is a natural protein fibre that needs suture removal and provokes a stronger inflammatory reaction. In the Terres et al. 2026 network meta-analysis, silk had only small-sample data (54 eyes), which showed more granulomas: fibrin glue versus silk had a granuloma odds ratio of 0.11 (95% CI 0.01-0.98), a wide interval that calls for cautious interpretation. If silk was used previously, discuss follow-up and management with your doctor.
How do I care for my eye post-op to lower recurrence, and what red flags need same-day review?
The three post-op essentials are sun protection, anti-inflammation, and follow-up: outdoors always wear UV400 or higher sunglasses and a wide-brim hat, since UV is the strongest environmental driver of recurrence; use steroid and antibiotic drops on your doctor's taper and do not stop on your own; follow-up timing is set by your doctor, with regular visits in the first year. Return the same day if you have sudden severe pain or vision loss, visible graft displacement, persistent redness or discharge, or enlarging bare sclera.