<b>Fibrin Glue versus Sutures for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review of Randomized Controlled Trials.</b>

Background: Conjunctival autografting reduces recurrence after pterygium excision, but the graft-fixation technique may influence operative time, ocular comfort, graft stability, and postoperative complications. Objective: To systematically synthesize randomized evidence comparing fibrin glue with sutures for securing conjunctival or limbal-conjunctival autografts in primary pterygium surgery. Methods: This systematic review used a foundational evidence search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL conducted through 8 November 2024. An updated search covering 9 November 2024 to 12 July 2026 was performed in PubMed and ClinicalTrials.gov, supplemented by reference-list screening and forward-citation searching. Two reviewers independently screened records, assessed eligibility, and extracted data. Disagreements were resolved by consensus, with third-reviewer adjudication available. Randomized controlled trials comparing commercial or autologous fibrin preparations with absorbable or non-absorbable sutures after primary pterygium excision were eligible. Published random-effects estimates were retained because complete trial-level datasets were unavailable; therefore, no new meta-analysis was conducted. Results: The foundational search identified 878 records. After removing 488 duplicates, 390 records were screened, 53 full-text reports were assessed, and 20 randomized controlled trials were included. The updated search identified no additional eligible direct-comparison trials. Recurrence favored fibrin glue, with an odds ratio for sutures versus glue of 2.46 (95% confidence interval, 1.06–5.69; P=0.035; I²=0%). Operative time was 15.65 minutes shorter with glue, and postoperative day 1 pain was lower. Considerable heterogeneity was observed for operative time and pain outcomes. Subconjunctival hemorrhage was reported in both groups, but inconsistent definitions and assessment periods prevented quantitative synthesis. Conclusion: This systematic review indicates that fibrin glue may reduce recurrence, shorten surgery, and improve early postoperative comfort compared with sutures. However, heterogeneity and inconsistent reporting limit certainty regarding the magnitude of benefit and complication risks.