Effect of fibrin glue on corneal lamellar healing and how it correlates to biomechanical properties: biomechanical wavefront analysis and confocal study

Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery

The cornea is the main refractive medium of the human eye, and its clarity is critical to visual acuity. Corneal optical density (COD) is an important index to describe corneal transparency. Intact corneal epithelial and endothelial cells, regular arrangement of collagen fibers in the stroma, and normal substance metabolism are all integral for the cornea to maintain its transparency. In the last two decades, the Pentacam Scheimpflug imaging system has emerged as a breakthrough for the measurement of COD (also called corneal densitometry). It has been found that a wide variety of factors such as age, refractive status, and corneal diseases can affect COD. Different corneal refractive surgery methods also change COD in different corneal regions and layers and affect visual acuity following the surgery. Thus, COD has gradually become a significant indicator to evaluate corneal health, one on which the attention of clinicians has been increasingly focused.

INTRAOCULAR APPLICATION OF FIBRIN GLUE AS AN ADJUNCT TO PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT

PURPOSE

To evaluate the efficacy of intraocular application of fibrin glue to seal the retinal breaks during standard pars plana vitrectomy for primary rhegmatogenous retinal detachment.

METHODS

Twenty-six eyes of 26 rhegmatogenous retinal detachment patients were included in the study. Fibrin glue was used to seal the retinal breaks during standard pars plana vitrectomy in all 26 eyes. Each eye was completely filled with a balanced saline solution at the end of the surgery. The success rate of the reattachment surgery, change in best-corrected visual acuity, intraocular pressure, and occurrence of intraoperative and postoperative complications were recorded and analyzed.

RESULTS

All eyes, with a mean age of 45.1 ± 18.3 years, were treated with pars plana vitrectomy surgery. During pars plana vitrectomy surgery, the fibrin glue showed excellent adherence and compliance to the retina. The glue was no longer visible through ultrasound scan 14.85 ± 4.56 days after surgery. The retinal breaks were sealed completely, and retina attached in all 26 eyes with no occurrence of rhegmatogenous retinal detachment during the follow-up period. The best-corrected visual acuity at 6 months after operation was significantly improved from preoperation best-corrected visual acuity. After operation, two eyes (2/26) developed an epiretinal membrane. Although three eyes (3/26) had a transient increased intraocular pressure during the 1st week after surgery, the intraocular pressure lowered to the normal range after the application of timolol. One eye (1/26) required daily topical antiglaucoma drops to lower the intraocular pressure. No adverse effects of fibrin glue were observed.

CONCLUSION

The fibrin glue provided a superior adhesive effect for sealing retinal breaks, while showing no additional adverse effects. It is a worthy alternative to gas tamponade for rhegmatogenous retinal detachment vitrectomy surgery.

Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study

Autologous matrix-induced chondrogenesis (AMIC) has gained popularity in the treatment of osteochondral lesions of the talus. Previous studies have presented promising short-term results for AMIC talar osteochondral lesion repair, a 1-step technique using a collagen type I/III bilayer matrix. The aim of the present study was to investigate the mid-term effects. The 5-year results of a prospective cohort study are presented. All patients underwent an open AMIC procedure for a talar osteochondral lesion. Data analysis included general demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1 and 5 years after surgery. The primary outcome variable was the longitudinal effect of the procedure, and the influence of various variables on the outcome was tested. Of 47 consecutive patients, 21 (45%) were included. Of the 21 patients, 8 were female (38%) and 13 were male (62%), with a mean age of 37 ± 15 (range 15 to 62) years and a body mass index of 26 ± 5 (range 20 to 38) kg/m². The defect size was 1.4 ± 0.9 (range 0.2 to 4.0) cm². The FFI-D decreased significantly from preoperatively to 1 year postoperatively (56 ± 18 versus 33 ± 25; p = .003), with a further, nonsignificant decrease between the 1- and 5-year follow-up examination (33 ± 25 versus 24 ± 21; p = .457). Similar results were found for the FFI-D subscales of function and pain. The body mass index and lesion size showed a positive correlation with the preoperative FFI-D overall and subscale scores. These results showed a significant improvement in pain and function after the AMIC procedure, with a significant return to sports by the 5-year follow-up point. The greatest improvement overall was seen within the first year; however, further clinical satisfaction among the patients was noticeable after 5 years.