Presentation on theme: "Use of fibrin glue in ocular surgery"— Presentation transcript:
1 Use of fibrin glue in ocular surgery Diane Marinho, Melissa M. Dal Pizzol, Sérgio Kwitko, Samuel RymerHospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - BrazilThe authors have no financial interest in the subject matter of this poster
2 Use of fibrin glue in ocular surgery 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.1,2Purpose:To evaluate the use of fibrin glue and its complications in different ophthalmic surgeriesUy HS, et al. Compararison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmol 2005;112(4):Kaufman HE, et al. Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion. Ophthalmol 2003; 110:
3 Methods: Retrospective and non-comparative study of 219 eyes. Use of fibrin glue in ocular surgeryMethods: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%.
4 Use 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).BA
5 Effective adherence of tissue was obtained in 95.4% of eyes. Use of fibrin glue in ocular surgeryResults: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).
6 Use of fibrin glue in ocular surgery Table 1Underlying diseaseACTAMTACT+ AMTALCTALTMicroperforation sealingClosure of clear corneal phacoemulsification incisionConjunctival closure of trabeculectomyTotalPterygium9411105Superior Limbic Keratoconjunctivitis516Limbal tumor24Conjunctivochalasis25Bullous Keratopathy35Limbal deficiency7Alkali burn1012Stevens-Johnson SyndromeCataractGlaucomaDALK8Trophic ulcer101789219ACT: Autologous conjunctival transplantationAMT: Amniotic membrane transplantationALCT: Autologous limbal conjunctival transplantationALT: Allogenic limbal transplantationDALK: Deep anterior lamellar keratoplasty
7 Use of fibrin glue in ocular surgery Table 2. Postoperative complicationsChemosisGranulomaHyperemiaDellenFailed closureDetachmentAutologous conjunctival transplantation6321Amniotic membrane transplantation5Autologous conjunctival transplantation and amniotic membrane transplantationAutologous limbal conjunctival transplantationClosure of clear corneal phacoemulsification incisionConjunctival closure of trabeculectomyMicroperforation sealing for DALKAllogenic limbal transplantationTotal (n=219)7 (3.2%)9 (4.1%)2 (0.9%)1 (0.4%)10 (4.5%)
8 Use of fibrin glue in ocular surgery 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.