The Use of Fibrin Glue in Conjunctival Limbal Autograft

Transplantation

The authors have no financial interest in the subject matter of this

poster

Yonca Aydin Akova MD, Leyla Erkanli Asena MD

Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey

ASCRS Symposium on Cataract, IOL and Refractive Surgery 2011, March 25-29 San Diego

Purpose

• To report the results of conjunctival limbal autograft transplantation (CLAT) surgery using fibrin glue in 3 patients with limbal stem cell deficiency

Patients and Methods• 3 eyes of 3 patients with

limbal stem cell deficiency (LSCD)– 2 patients with chemical (alkali)

injury– 1 patient following long term

treatment for acanthamoeba keratitis

• CLAT surgery using fibrin glue – Only few fixation sutures on

the conjunctival side for ensuring graft stability

– No sutures on the corneal side• The mean duration of

postoperative follow-up – 23,3 (18-30) weeks

Outcome variables• Pre- and

postoperative best corrected visual acuities (BCVA)

• Duration of the surgical procedure

• Graft stability • Complications

Results

• The mean duration of the surgical procedure was 40,7 (34-48) minutes – Directly proportional to the

time needed for superficial keratectomy

• Visual acuity increased in all patients

• Patient comfort was satisfactory– Decreased pain and

inflammmation• No intra- or

postoperative complications

• The graft was stable in two patients

• Minimal graft retraction in one patient due to vigorous eye-rubbing

Preoperative BCVA (Snellen)

Patient 1: 0.1Patient 2: 0,3 Patient 3: 0,4

Postoperative BCVA (Snellen)Patient 1: 0,8Patient 2: 0,5 Patient 3: 0,7

Patient 2

Patient 1

• Postoperative week 1

• Postoperative month 2

Patient 3

• Postoperative Day 1 • Postoperative Week 1

• Preoperative

Limbal Stem Cell Deficiency Etiology

Trauma• Chemical injury, thermal injury, recurrent

surgery, long term contact lens wear Inflammation • Stevens-Johnson Syndrome, Ocular

Cicatricial Pemphigoid, severe microbial keratitis

Other• Aniridia, multiple endocrine neoplasia

associated keratitis

Clinical Findings Therapy• Corneal surface

irregularity• Punctate superficial

flourescein staining- epithelial defects

• Conjunctival epithelial cells migrating from the limbus to the central cornea “conjunctivalization”

• Corneal neovascularisation

• Chronic corneal inflammation, scarring and ulcer formation

• Antiinflammatory agents

• Topical and subconjunctival bevacizumab

• Amniotic membrane transplantation

• Penetrating keratoplasty combined with limbal stem cell transplantation

• Unilateral cases- Conjunctival limbal autograft transplantation

– Fibrin glue

Limbal Stem Cell Deficiency

Sutureless Conjunctival Limbal Autograft Transplantation with Fibrin Glue

Fibrin Glue Advantages:• Decreased duration of surgery• Better tissue apposition• Decreased risk for postoperative wound infections

– Suture related infections↓– Antimicrobial activity of aprotinine (?)

• Increased patient comfortFibrin Glue Disadvantages :• Allergic reactions due to aprotinine

– Rare• Cost?

– ~132 $ per ml (one patient)

Panda A, Kumar S. et all. Indian J Ophthalmol 2009;57:371-179 Chen Wl, Lin CT. et. all. Cornea 2007;26:1228-1234

ConclusionThe use of fibrin glue in

CLAT • Decreases the duration of

the surgical procedure • Decreases the rate of suture

related complications– Debris accumulation– Wound infection

• Increased patient comfort

Postoperative

A rational alternative in the surgical treatment of LSCD

Preoperative