Fibrin Glue Versus Absorbable Sutures for Conjunctival Closure in Pediatric Strabismus Surgery: A Comparative Study of Clinical Outcomes and AS-OCT Findings

<b>Background/Objectives:</b> Conjunctival closure may influence early postoperative comfort and wound healing after pediatric strabismus surgery. We compared fibrin glue with absorbable sutures using anterior segment optical coherence tomography (AS-OCT)-based conjunctival thickness, serial clinical scores, ocular-surface screening, and operative time. <b>Methods:</b> We retrospectively reviewed 82 children (5-15 years) who underwent bilateral medial rectus recession. The conjunctiva was closed with 8-0 polyglactin 910 (Vicryl) (suture group, <i>n</i> = 40) or fibrin glue (fibrin group, <i>n</i> = 42) according to routine practice; right eyes were analyzed. Conjunctival thickness was measured by AS-OCT preoperatively and at week 6. The comfort questionnaire (CQ) score and inflammation score (IS) were recorded on postoperative day 1 and weeks 1, 2, and 6. Total operative time and closure time were obtained from surgical video recordings. Ocular Surface Disease Index-6 (OSDI-6) and non-invasive keratographic break-up time (NIKBUT) were assessed preoperatively and at week 6 in cooperative children (<i>n</i> = 62). <b>Results:</b> Conjunctival thickness increased in both groups and was slightly higher at week 6 with sutures (<i>p</i> < 0.001), with a slightly greater percentage increase (<i>p</i> = 0.001). CQ and IS were worse with sutures through week 2 (all <i>p</i> < 0.05) and converged by week 6 (both <i>p</i> > 0.05). Fibrin glue shortened total operative time (32.75 vs. 35.46 min; <i>p</i> < 0.05) and closure time (3.90 vs. 5.35 min; <i>p</i> < 0.001). In the ocular-surface subset, OSDI-6 and NIKBUT did not differ between groups at week 6. No infections or granulomas occurred; two early conjunctival wound gaps occurred in the fibrin group and one resolved with topical management, while the other met the dehiscence definition (≥2 mm) and required re-suturing, and both healed without sequelae. <b>Conclusions:</b> In pediatric strabismus surgery, fibrin glue demonstrated better early comfort with a modest difference in conjunctival thickness at week 6 along with slightly shorter operative time while clinical scores converged by week 6, and ocular-surface screening outcomes were similar.