A Comparative Study of Fibrin Glue and Suture Closure for Compromised Scleral Flaps in Manual Small-Incision Cataract Surgery (SICS)

Abstract

Background: Compromised scleral flaps, resulting from extension or buttonholing during manual small-incision cataract surgery (SICS), can lead to wound leakage, shallow anterior chamber, postoperative astigmatism, and increased risk of endophthalmitis. Conventionally, these defects are managed using sutures, which may cause postoperative discomfort and require subsequent removal. Fibrin glue has emerged as a biological tissue adhesive that may provide effective wound closure while minimizing suture-related complications. This study compared the safety and efficacy of fibrin glue with X-shaped infinity sutures for the management of compromised scleral flaps during SICS.

Methods: A prospective, comparative, single-centre study was conducted among 30 patients aged 55–65 years with compromised scleral flaps encountered during SICS. Patients were equally divided into two groups: Group A (n=15) underwent wound closure using fibrin glue, while Group B (n=15) received X-shaped infinity sutures. All surgeries were performed by a single surgeon using a standardized technique. Postoperative evaluation over six months included wound integrity, anterior chamber depth, intraocular pressure, inflammation, surgically induced astigmatism (SIA), and patient comfort.

Results: Both groups were comparable with respect to baseline demographic and ocular parameters. No statistically significant differences were observed in postoperative inflammation or surgically induced astigmatism during the six-month follow-up. Mean SIA at six months was 1.73 ± 0.77 D in the fibrin glue group and 1.76 ± 1.23 D in the suture group. Patients treated with fibrin glue experienced no postoperative discomfort, whereas five patients in the suture group developed foreign body sensation and conjunctival hyperaemia requiring suture removal.

Conclusion: Fibrin glue is a safe and effective alternative to X-shaped infinity sutures for managing compromised scleral flaps during manual SICS. It provides secure wound closure, minimizes postoperative discomfort and suture-related complications, preserves astigmatic outcomes comparable to sutures, reduces inflammation, and shortens surgical time. Fibrin glue may therefore be considered a valuable option for the management of extended or buttonholed scleral flaps during cataract surgery.