use of fibrin glue in ocular surgery diane marinho, melissa m. dal pizzol, sérgio kwitko, samuel...
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Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
Diane Marinho, Melissa M. Dal Pizzol, Sérgio Kwitko, Samuel Rymer
Hospital de Clínicas de Porto AlegreFederal University of Rio Grande do Sul - Porto Alegre - Brazil
The authors have no financial interest in the subject matter of this poster
Human fibrin adhesives have become increasingly popular adjuncts to various ophthalmic surgeries. They are biodegradable into nontoxic metabolites. Some advantages are that the surgery is faster with improved hemostasis, with less postoperative discomfort and inflammation.1,2
• Purpose:Purpose:To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
1. Uy HS, et al. Compararison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmol 2005;112(4): 667-671.2. Kaufman HE, et al. Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion. Ophthalmol 2003; 110: 2168-2172.
• Methods:Methods: Retrospective and non-comparative study of 219 eyes.
Fibrin glue (Beriplast P®, Aventis-Behring, Germany) was used in all patients for tissue adherence or incision closure (Table 1).
Surgeries performed were:- autologous conjunctival transplantation (ACT) in 46.1%
- amniotic membrane transplantation (AMT) in 35,6%
- autologous limbal conjunctival transplantation (ALCT) in 4.1% (Figure 1)
- alogenic limbal transplantation (ALT) in 0,9%
- Descemet´s membrane microperforation sealing in deep lamellar anterior keratoplasty (DALK) in 3,6%
- clear corneal phacoemulsification incision in 2.3%
- conjunctival closure of trabeculectomy in 2.3%
- ALCT associated with AMT in 5%.
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
Figure 1. Intraoperative use of fibrin glue to attach ALCT after pterygium excision (A) and same patient 15 days after the surgery (B).
A B
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
• Results:Results:
Effective adherence of tissue was obtained in 95.4% of eyes.
Detachment of the graft occurred in 10 cases (7 in AMT for bullous keratopathy, 2 in ACT for pterygium surgery, and one in ALCT in Stevens-Johnson Syndrome).
Granulomatous foreign body reaction developed in 9 eyes (5 in AMT for acute alkali injury, one in ALT for a chronic burn injury, and 3 in ACT in pterygium surgery).
Fail to seal Descemet´s membrane perforation during DALK was noted in two eyes (Table 2).
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
Underlying disease ACT AMT ACT+
AMT
ALCT ALT Microperforation sealing
Closure of clear corneal phacoemulsification
incision
Conjunctival closure of
trabeculectomy
Total
Pterygium 94 11 105
Superior Limbic Keratoconjunctivitis
5 1 6
Limbal tumor 2 2 4
Conjunctivochalasis 25 25
Bullous Keratopathy 35 35
Limbal deficiency 7 7
Alkali burn 10 1 1 12
Stevens-Johnson Syndrome
1 1 2
Cataract 5 5
Glaucoma 5 5
DALK 8 8
Trophic ulcer 5 5
Total 101 78 11 9 2 8 5 5 219
ACT: Autologous conjunctival transplantationAMT: Amniotic membrane transplantation ALCT: Autologous limbal conjunctival transplantation ALT: Allogenic limbal transplantation DALK: Deep anterior lamellar keratoplasty
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
Table 1
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
Table 2. Postoperative complications
Chemosis Granuloma Hyperemia Dellen Failed closure Detachment
Autologous conjunctival transplantation 6 3 2 1 0 3
Amniotic membrane transplantation 0 5 0 0 0 6
Autologous conjunctival transplantation and amniotic membrane transplantation
0 0 0 0 0 0
Autologous limbal conjunctival transplantation 1 1 0 0 0 1
Closure of clear corneal phacoemulsification incision
0 0 0 0 0 0
Conjunctival closure of trabeculectomy 0 0 0 0 0
Microperforation sealing for DALK 0 0 0 0 2
Allogenic limbal transplantation 0 0 0 0 0 0
Total (n=219) 7 (3.2%) 9 (4.1%) 2 (0.9%) 1 (0.4%) 2 (0.9%) 10 (4.5%)
Use of fibrin glue in ocular surgeryUse of fibrin glue in ocular surgery
• Conclusion:Conclusion:
Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation and incision closure, with low rates of complications in ocular surface and anterior segment surgeries.