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Lopezcarasa-Hernandez G, Perez-Vazquez JF, Guerrero-Naranjo JL, Martinez-Castellanos MA. Versatility of use of fibrin glue in wound closure and vitreo-retinal surgery. Int J Retina Vitreous 2021; 7:33. [PMID: 33858517 PMCID: PMC8050906 DOI: 10.1186/s40942-021-00298-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fibrin glue is an absorbable blood-derived product, a biological tissue adhesive which imitates the final stages of the coagulation cascade, it produces a firm clot, forming a seal along the whole length of the wound, the resultant fibrin clot degrades physiologically into granulation tissue 2 weeks after the application. Biological glue has been used extensively in many forms of surgical procedures. Its use in eye surgery has grown lately as we have evidence that showed it was effective in securing conjunctival grafts in pterygium surgery, in securing wounds after glaucoma surgery and more importantly in 20G and 23G vitrectomy. Purpose The aim of this study is to present our experience in the use of fibrin glue in vitreoretinal surgery. Material and methods We included 281 eyes of 221 patients who underwent vitreoretinal surgery during the period of May 2009 to July 2012, the preoperative diagnoses were as following: proliferative diabetic retinopathy, rhegmatogenous retinal detachment, macular hole, epiretinal membrane, luxation of cataratous nucleous and cortex, intraocular lens luxation, penetrating trauma, silicone extraction, phaco + IOL + vitrectomy + Ahmed valve implant, vitreous biopsy and optic nerve pit associated to macular detachment. The procedures were performed with Alcon Accurus Surgical System 20-gauge, 23-gauge or a combination of both. We used fibrin glue in all of the 20-gauge sclerotomies and leaking 23-gauge sclerotomies, scleral wound for IOL extraction, conjunctival peritomy for buckle implantation, conjunctiva in Ahmed valve implant, corneal graft in corneal perforation in trauma and leaking corneal wounds for phacoemulsification, in an optic pit, and in subretinal space in a giant retinal tear. Results We did not use any suture in any of the patients throughout the different procedures, there was no leakage in any wounds in the postoperative period, we found no inflammatory reaction, infection, and whenever we had excess amount, it was trimmed. Two patients presented a small dehiscence of the wound that was corrected in-office with a small amount of fibrin glue in the post-operative period. Conclusions Fibrin glue reduces surgical time, it is a good sealant, safe, with minimal allergic or toxic reactions and inflammation, minimizes bleeding, easy to undo and that eventually degrades. This small series shows that fibrin glue is a viable alternative for tissue coaptation in vitreoretinal surgery. However, further studies are required before fibrin glue takes the place of sutures.
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Affiliation(s)
- Gabriela Lopezcarasa-Hernandez
- Retina and Vitreus Department, Asociacion para Evitar la Ceguera en México, IAP, Vicente García Torres 46, Col. Barrio San Lucas, Coyoacan, 04030, Mexico City, Mexico. .,Hospital Angeles Lomas, Mexico City, Mexico.
| | - Jose-Francisco Perez-Vazquez
- Retina and Vitreus Department, Asociacion para Evitar la Ceguera en México, IAP, Vicente García Torres 46, Col. Barrio San Lucas, Coyoacan, 04030, Mexico City, Mexico
| | - Jose-Luis Guerrero-Naranjo
- Retina and Vitreus Department, Asociacion para Evitar la Ceguera en México, IAP, Vicente García Torres 46, Col. Barrio San Lucas, Coyoacan, 04030, Mexico City, Mexico
| | - Maria A Martinez-Castellanos
- Retina and Vitreus Department, Asociacion para Evitar la Ceguera en México, IAP, Vicente García Torres 46, Col. Barrio San Lucas, Coyoacan, 04030, Mexico City, Mexico
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López-Guajardo L, Benítez-Herreros J, Donate-López J, Opazo-Toro V. Evaluation of leakage resistance improvement in transconjunctival sutureless vitrectomy sclerotomies closed with adhesives. an experimental study. Eye (Lond) 2019; 34:1229-1234. [PMID: 31685969 PMCID: PMC7314807 DOI: 10.1038/s41433-019-0651-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/15/2019] [Accepted: 10/13/2019] [Indexed: 01/25/2023] Open
Abstract
Background The purpose of this paper is to study the utility of adhesives (artificial-cyanoacrylate and biological-fibrin glue) for improving transconjunctival sutureless vitrectomy (TSV) sclerotomy closure competency. Methods Experimental and observer-masked study in which after performing TSV in cadaveric pig eyes, different adhesives were tested on sclerotomy entrances in order to determine if they improved closure competency in face of progressive intraocular pressure increase. In 76 eyes cyanoacrylate-treated sclerotomies were compared with sclerotomies in which no additional manoeuvre to aid closing was performed; in 76 eyes fibrin glue with no manoeuvre; and in the last 76 eyes, cyanoacrylate-treated sclerotomies were compared with fibrin glue-treated sclerotomies. Results A total of 228 eyes had a 23-gauge TSV performed. Both cyanoacrylate and fibrin glue treated sclerotomies achieved higher mean opening pressures when compared with nontreated sclerotomies in the same eye (p < 0.002). When cyanoacrylate was compared with biological adhesive in the same eye, no statistically significant differences were obtained (p = 0.216). Discussions This experimental study provides support for the possible role of adhesives in improving TSV sclerotomy closure competency in clinical practice.
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Affiliation(s)
- Lorenzo López-Guajardo
- Ophthalmology Department, Hospital Clínico "San Carlos", Madrid, Spain. .,Ophthalmology Department, Hospital Universitario "Príncipe de Asturias". Alcalá de Henares, Madrid, Spain. .,Universidad Complutense, Madrid, Spain.
| | - Javier Benítez-Herreros
- Ophthalmology Department, Hospital Universitario "Príncipe de Asturias". Alcalá de Henares, Madrid, Spain
| | - Juan Donate-López
- Ophthalmology Department, Hospital Clínico "San Carlos", Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Valeria Opazo-Toro
- Ophthalmology Department, Hospital Universitario "Príncipe de Asturias". Alcalá de Henares, Madrid, Spain
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Mercieca KJ, Fenerty CH, Steeples LR, Drury B, Bhargava A. Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management: A Comparative Laboratory Study. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Aquino MC, Lim D, Chew PTK. Micropulse P3™ (MP3) Laser for Glaucoma: An Innovative Therapy. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018; 12:40-44. [PMID: 29861581 PMCID: PMC5981092 DOI: 10.5005/jp-journals-10028-1242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/09/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures. Materials and methods Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, cross-sectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland-Altman plots were used to assess reliability of measurements and their differences at the two altitudes. Results The mean age of patients was 41.7 (28-66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically sig -nificant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 μm, p = 0.496). Conclusion Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.How to cite this article: Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018;12(1):40-44.
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Affiliation(s)
- Oscar Albis-Donado
- Associate Professor, Department of Ophthalmology, Instituto Mexicano de Oftalmologia, Queretaro, Mexico and Omesvi Diagnostic Group Mexico City, Mexico
| | - Shibal Bhartiya
- Senior Consultant, Department of Ophthalmology, Glaucoma Facility, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Marina Gil-Reyes
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Giovanna Casale-Vargas
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Nancy Arreguin-Rebollar
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Malik Y Kahook
- Professor, Department of Ophthalmology, School of Medicine, University of Colorado, Denver, Colorado, USA
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Alaghband P, Rodrigues IA, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018; 12:45-49. [PMID: 29861582 PMCID: PMC5981093 DOI: 10.5005/jp-journals-10028-1243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022] Open
Abstract
Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechia! angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic-GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery. How to cite this article: Alaghband P, Rodrigues IAS, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018;12(1):45-49.
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Affiliation(s)
- Pouya Alaghband
- Registrar, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
| | - Ian As Rodrigues
- Consultant, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
| | - Saurabh Goyal
- Consultant, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
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Sheng Lim K, Garg A, Cheng J, Muthusamy K, Beltran-Agullo L, Barton K. Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber. J Curr Glaucoma Pract 2018; 12:36-39. [PMID: 29861580 PMCID: PMC5981091 DOI: 10.5005/jp-journals-10028-1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction To compare the early postoperative hypotony rates and intraocular pressure (IOP) in two groups of eyes using either 23-gauge (23G) or 25-gauge (25G) needle in the creation of the anterior chamber entry tract for Baerveldt tube. The primary outcome measure was incidence of hypotony, and secondary outcome measures included comparison of mean IOP and other early complications. Materials and methods Ours was a retrospective case review of consecutive patients who underwent 350 mm2 Baerveldt implantation in two units over a 2-year period. Data including IOP and complications were collected at 1 day, 1 week, and 1 month following surgery from patients’ notes. Statistical analysis between groups was determined using the unpaired 2-tailed f-test for continuous variables and chi-squared test for categorical variables. Statistical significance was defined at the 0.05 level. Results A total of 58 eyes of 58 patients were included in this study. Preoperative mean IOP in the 25G group was significantly higher (26.4 ± 6.8 mm Hg) when compared with the 23G group (21.6 ± 4.0 mm Hg) (p = 0.002). The mean postoperative IOP remained significantly higher in the 25G group at day 1 (p=0.004), week 1 (p = 0.008), but not at month 1 (p = 0.744). Four patients in the 23G group had hypotony within 1 month postsurgery compared with no cases in the 25G group (chi-squared test p = 0.038). Conclusion There was a significantly higher risk of early hypotony and lower IOP in the larger 23G group at days 1 and 7, although the IOP was similar in both groups by 1 month. Clinical significance After all glaucoma drainage device (GDD) tube implantation, regardless of which needle is used to create the tract, the entry site should always be checked with 2% fluorescein drop and 10.0 nylon suture is used with or without autologous Tenon’s tissue to close any leakage. How to cite this article: Lim KS, Garg A, Cheng J, Muthusamy K, Beltran-Agullo L, Barton K. Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber. J Curr Glaucoma Pract 2018;12(1):36-39.
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Affiliation(s)
- Kin Sheng Lim
- Consultant, Department of Ophthalmology, Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anurag Garg
- Specialist Registrar, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Jason Cheng
- Fellow, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Kirithika Muthusamy
- Specialist Registrar, Department of Ophthalmology, Moorfields Eye Hospital London, United Kingdom
| | - Laura Beltran-Agullo
- Fellow, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Keith Barton
- Consultant, Department of Ophthalmology, Moorfields Eye Hospital London, United Kingdom
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Trevino R, Sponsel WE, Majcher CE, Allen J, Rabin J. Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma. J Curr Glaucoma Pract 2018; 12:29-35. [PMID: 29861579 PMCID: PMC5981090 DOI: 10.5005/jp-journals-10028-1240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022] Open
Abstract
Aim To determine the association of Diopsys® NOVA-LX amplitude and latency abnormality scores with perimetric staging of chronic glaucoma, and to explore potential single-visit short-duration transient visual evoked potential (SD-tVEP) trend detection ability utilizing Humphrey 30-2 field progression data. Materials and methods Setting: Glaucoma subspecialty clinic. Participants: Treated adult chronic glaucoma patients undergoing SD-tVEP evaluation. Main outcome measures: (1) Proportion of eyes designated as suspect or abnormal by the NOVA-LX multifactorial algorithm were determined as a function of glaucoma severity using the most recent Humphrey visual field analyzer (HVFA) 30-2 field. (2) Association between long-term HVFA-guided progression analysis (GPA) annual slopes and SD-tVEP abnormality was assessed to determine whether a single VEP test might help to identify eyes more prone to progressive visual field (VF) loss. Results One hundred and thirty-three eyes of 84 patients (mean age 68 years) were analyzed. The SD-tVEP abnormality increased proportionately with severity of VF loss under high-contrast (Hc) test conditions for both latency (p = 0.001) and amplitude (p < 0.01). The HVFA progression analysis printouts existed for 91 eyes (mean 12.3 fields per eye/range 5-18). Nearly three-quarters (72.5%) of eyes with mean annual HVFA progression >0.7 dB/year (n = 29) had single-visit VEP latency abnormalities. Fewer than half (46.7%) of the remainder (n = 62) showed latency abnormality. Mean progression for eyes with abnormal vs normal VEP latency was -0.87 ± 0.3 dB/year vs -0.32 ± 0.4 dB/year. Conclusion Diopsys NOVA-LX Hc latency abnormality shows strong association with VF loss among a diverse population of clinical patients undergoing active treatment for chronic glaucoma, and appears likely to afford clinically useful trend-detecting test. Clinical significance The SD-tVEP has the potential to serve as a single-visit clinical indicator to identify glaucoma patients at high risk for VF progression. How to cite this article: Trevino R, Sponsel WE, Majcher CE, Allen J, Rabin J. Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma. J Curr Glaucoma Pract 2018;12(1):29-35.
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Affiliation(s)
- Richard Trevino
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - William E Sponsel
- Director, Professor and Consultant, Department of Ophthalmology, CLI Eyes of Africa Clinic and Surgery Center, Malawi, Africa; WESMDPA Baptist Medical Center Glaucoma Service, San Antonio, Texas; Department of Biomedical Engineering, University of Texas San Antonio, San Antonio, Texas; Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Carolyn E Majcher
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Joey Allen
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Jeffery Rabin
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
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Thangamathesvaran L, Crane E, Modi K, Khouri AS. Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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J Lu L, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018; 12:19-28. [PMID: 29861578 PMCID: PMC5981089 DOI: 10.5005/jp-journals-10028-1239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/09/2017] [Indexed: 11/23/2022] Open
Abstract
Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review. How to cite this article: Lu LJ, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018;12(1):19-28.
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Affiliation(s)
- Louise J Lu
- Medical Student, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Laura Hall
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Ji Liu
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
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Dong J, Syed ZA, Fan K, Yahya AF, Melki SA. Potential Savings from Visit Reduction of Continuous Intraocular Pressure Monitoring. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Suncon medical adhesive is a suitable alternative to fibrin glue in the 23G minimally invasive vitrectomy. Exp Ther Med 2017; 14:623-625. [PMID: 28672976 PMCID: PMC5488637 DOI: 10.3892/etm.2017.4520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2017] [Indexed: 11/29/2022] Open
Abstract
Fibrin glue is frequently used to close the incision of the sclera and conjunctiva. However, its use is limited due to its blood-borne origins. The study evaluated the suitability of Suncon medical adhesive as a replacement for fibrin glue in 23G minimally invasive vitrectomy as an animal study. One eye of Japanese white rabbits (total, 18 rabbits) received an intravitreal injection of 0.05 ml of Suncon medical adhesive, while the other eye was injected with 0.05 ml of saline and served as the control eye. Slit lamp, indirect ophthalmoscope and electroretinogram (ERG) examinations were carried out before and 28 days after the interventions. At the end of the observation period (28 days), ophthalmectomy was performed for the light microscopy examination. ERG measurements included the b-wave amplitude of rod cell response (Rod-R), maximum mixing response (Max-R) and cone cell response (Cone-R), P2-wave amplitude of oscillatory potentials (Ops) and mean amplitude of 30 Hz scintillation response. The slit lamp examination showed no abnormal inflammatory reactions in the control or treatment eyes. The difference in ERG measurements was not statistically significant between the control or treatment eyes. Furthermore, the cells in each layer of retinas exposed to Suncon medical adhesive or saline were morphologically normal under light microscopy. In conclusion, Suncon medical adhesive injected at doses of 0.05 ml is well-tolerated by the retina. Therefore, the Suncon medical adhesive is a suitable alternative to fibrin glue.
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Lima LH, Morales Y, Cabral T. Poly- N-isopropylacrylamide (pNIPAM): a reversible bioadhesive for sclerotomy closure. Int J Retina Vitreous 2016; 2:23. [PMID: 27847641 PMCID: PMC5088454 DOI: 10.1186/s40942-016-0048-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/17/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To determine the safety and efficacy of poly-N-isopropylacrylamide, a thermoresponsive adhesive, for sutureless sclerotomy closure in rabbits. METHODS Eight rabbits were randomized into three groups: short-term acute, mid-term chronic, and long-term chronic studies. A corresponding control group in which the scleral wounds were sutured by 6-0 vicryl sutures was assigned for each study group. A 20-gauge sclerotomy was performed following a core vitrectomy and 0.1 mL of 50 % liquid poly-N-isopropylacrylamide was applied to the scleral wounds. Before the polymer application, the scleral surface was raised above 32 °C using a halogen bulb lamp. Follow-up exams included color external and fundus photography, fundus fluorescein angiography, optical coherence tomography, and electroretinography. After the last follow-up assessment, the rabbits were sacrificed and histopathological studies on the scleral incision sites were performed. RESULTS Scleral wound healing was observed in the long-term chronic study rabbits. Histological studies were able to identify poly-N-isopropylacrylamide polymer at the sclerotomy site in the mid-term chronic study rabbits. Besides iatrogenic cataracts due to mechanical instrument touch in 2 rabbits, no other ocular abnormalities were identified in any of the eyes in the perioperative setting or during the follow-up period. Cornea, retina, and vitreous remained unaffected, and no abnormal inflammatory reaction or endophthalmitis was noticed in the 3 study groups. Filtering blebs indicative of leakage through the sclerotomies were not observed during the follow-up period. CONCLUSION Poly-N-isopropylacrylamide may provide effective in vitro scleral adhesion above 32 °C. Clinical studies are required to evaluate its utility in patients undergoing pars plana vitrectomy.
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Affiliation(s)
- Luiz H Lima
- Doheny Eye Institute, University of California Los Angeles (UCLA), Los Angeles, CA USA ; Federal University of Sao Paulo (UNIFESP), Rua Botucatu, 821, Vila Clementino, Sao Paulo, São Paulo 04023-062 Brazil
| | - Yael Morales
- Doheny Eye Institute, University of California Los Angeles (UCLA), Los Angeles, CA USA
| | - Thiago Cabral
- Federal University of Sao Paulo (UNIFESP), Rua Botucatu, 821, Vila Clementino, Sao Paulo, São Paulo 04023-062 Brazil
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Hoshi S, Okamoto F, Arai M, Hirose T, Fukuda S, Sugiura Y, Oshika T. Polyethylene Glycol-Based Synthetic Hydrogel Sealant for Closing Vitrectomy Wounds: An In Vivo and Histological Study. Transl Vis Sci Technol 2016; 5:7. [PMID: 27226931 PMCID: PMC4874449 DOI: 10.1167/tvst.5.3.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/03/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose We conducted an in vivo study using Dutch pigmented rabbit eyes to test the usefulness of polyethylene glycol (PEG) sealant for the closure of sutureless sclerotomies in microincisional vitrectomy surgery (MIVS). Methods Three-port, 23-gauge vitrectomy was performed on rabbit eyes. After air leakage was confirmed by the application of 0.625% povidone–iodine at the sclerotomy site, PEG sealant was subconjunctivally injected using a 27-gauge needle through conjunctival incisions to cover the sclerotomy wounds, following which it was polymerized by the application of xenon light for 60 seconds. Ophthalmological examinations and intraocular pressure measurements were conducted the day before and 1, 3, 5, and 7 days after surgery. The eyes were enucleated for histological evaluation 7 days after surgery. Results PEG sealant was rapidly polymerized by the application of xenon light after subconjunctival injection, and it firmly sealed the sclerotomies without air leakage, as confirmed by povidone–iodine dropping, in all cases. Conjunctival and scleral wounds closed with PEG sealant were successfully attached and remained intact till the end of the follow-up period. There was no sign of postoperative hypotony or infection in any eye, and no adverse effects of PEG sealant were found. In histological examination, linear scar formation and eosinophilic staining of collagen fibers were observed at the sclerotomy sites, while the sclerotomy tunnels appeared tightly closed. Conclusions PEG sealant can be useful for the closure of sutureless 23-gauge vitrectomy incisions in rabbits. Translational Relevance The PEG sealant may become an effective option for closing vitrectomy incisions including pediatric cases.
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Affiliation(s)
- Sujin Hoshi
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mikki Arai
- Arai Eye Clinic, Fukuoka, Japan ; The Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Tatsuo Hirose
- The Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA ; Boston Eye Group, Brookline, MA, USA
| | - Shinichi Fukuda
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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15
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Diathermy of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: a prospective study. Retina 2013. [PMID: 23190925 DOI: 10.1097/iae.0b013e3182725d65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of bipolar diathermy in ensuring closure of leaking sclerotomies after complete 23-gauge transconjunctival sutureless vitrectomy. METHODS In this prospective, interventional case series, in 136 eyes of 136 patients with at least one leaking sclerotomy at the end of a complete 23-gauge transconjunctival sutureless vitrectomy, external bipolar wet-field diathermy was applied to leaking sclerotomies, including the conjunctiva and sclera. Intraoperative wound closure, and postoperatively, at 6 hours, 1 day and 3 days, sclerotomies leakage, intraocular pressure, hypotony, and hypotony-related complications were evaluated. RESULTS Intraoperative closure was achieved in 231 of 238 leaking sclerotomies (97%) that received diathermy. One of these with postoperative leakage needed suture. Compared with baseline (14.4 ± 2.8 mmHg), mean intraocular pressure was lower at 6 hours (13.2 ± 3.8 mmHg, Tukey-Kramer P < 0.001) and not different at 24 hours or 72 hours. Hypotony (intraocular pressure <5 mmHg) was observed in 6 eyes (4.5%) at 6 hours, in 2 (1.5%) at 24 hours, and in none at 3 days. Logistic regression analysis showed that, 6 hours postoperatively, hypotony was related to younger age (≤50 years) at surgery (P = 0.031). No hypotony-related complications were recorded. CONCLUSION Bipolar wet-field diathermy of sutureless sclerotomies is an effective method for ensuring a leaking sclerotomies closure.
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Martinez-de-la-Casa JM, Rayward O, Saenz-Frances F, Mendez C, Bueso ES, Garcia-Feijoo J. Use of a fibrin adhesive for conjunctival closure in trabeculectomy. Acta Ophthalmol 2013; 91:425-8. [PMID: 22551449 DOI: 10.1111/j.1755-3768.2012.02436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo(®) ) used to close the conjunctiva in trabeculectomy. METHODS A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. RESULTS No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo(®) group. Two patients in the Tissucol Duo(®) group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. CONCLUSION The use of Tissucol Duo(®) seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.
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Affiliation(s)
- José M Martinez-de-la-Casa
- Ophthalmology Department, Clinico San Carlos Hospital, Ophthalmology Department of Medicine School, Complutense University of Madrid, Health Investigative Institute of Clinico San Carlos Hospital (IdISSC), Madrid, Spain.
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18
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Sakarya Y, Sakarya R, Kara S, Soylu T. Fibrin glue coating of the surgical surfaces may facilitate formation of a successful bleb in trabeculectomy surgery. Med Hypotheses 2011; 77:263-5. [DOI: 10.1016/j.mehy.2011.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 04/12/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
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Lee JH, Kang NY. Comparison of fibrin glue and sutures for conjunctival wound closure in strabismus surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:178-84. [PMID: 21655043 PMCID: PMC3102821 DOI: 10.3341/kjo.2011.25.3.178] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 09/06/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery. Methods In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated. Results One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed. Conclusions Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.
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Affiliation(s)
- Jae Hyung Lee
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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20
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Thompson JT. Advantages and limitations of small gauge vitrectomy. Surv Ophthalmol 2011; 56:162-72. [PMID: 21236459 DOI: 10.1016/j.survophthal.2010.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/29/2010] [Accepted: 08/03/2010] [Indexed: 10/25/2022]
Abstract
Small gauge vitrectomy utilizing 23- and 25-gauge instrumentation has definite advantages, but also limitations, due to the physics of smaller instruments and sutureless surgery. Higher infusion and aspiration pressures are needed to remove the vitreous using 23- and 25-gauge probes. The advantages include decreased surgical times, less tissue manipulation, reduced inflammation and pain postoperatively with more rapid visual recovery. A disadvantage is greater instrument flexion than 20-gauge probes, making small gauge vitrectomy more appropriate for indications such as vitreous opacities, epiretinal membranes, macular holes, and simple retinal detachments. There are also some increased complications related to small gauge vitrectomy, including dislocation of cannulas intraoperatively, early postoperative hypotony, choroidal detachment, and possibly an increased risk of infectious endophthalmitis.
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21
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Singh A, Hosseini M, Hariprasad SM. Polyethylene glycol hydrogel polymer sealant for closure of sutureless sclerotomies: a histologic study. Am J Ophthalmol 2010; 150:346-351.e2. [PMID: 20579628 DOI: 10.1016/j.ajo.2010.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/05/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate a polyethylene glycol-based hydrogel bandage for its ability to secure sutureless pars plana vitrectomy sclerotomies. DESIGN Laboratory investigation. METHODS Twenty-gauge (20-G) and twenty-three gauge (23-G) sclerotomies were constructed in human cadaveric eyes. A total of 24 sclerotomies were constructed in 6 eyes. Four sclerotomies per eye were constructed. Two were straight 20-G incisions, of which 1 was sutured and 1 was covered with the bandage. The other 2 were 23-G beveled incisions, of which 1 was left bare and the other was closed with the hydrogel bandage. India ink was applied over the sclerotomy sites while the intraocular pressure (IOP) was varied. The presence of India ink particles along incisions was evaluated by histologic analysis. RESULTS The hydrogel bandage prevented the entry of ink particles in all covered incisions after IOP modulation and incision manipulation. One 20-G sutured incision showed partial ink ingress. Four uncovered 23-G incisions showed the presence of ink within the inner aspect of the incisions (P = .0455 relative to 23-G sealed incisions). Twenty-two out of 24 incisions were evaluated, as 2 incisions could not be identified on histologic analysis. CONCLUSIONS The use of a hydrogel bandage to close sutureless sclerotomies is a practical alternative to sutures. Closure of sutureless sclerotomies may reduce the entry of ocular surface fluid into these incisions as well as prevent leakage of intraocular fluid in the immediate postoperative period. Incision closure may reduce the incidence of postoperative endophthalmitis and hypotony in sutureless vitreous surgery.
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Lee GA, Holcombe DJ. Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue. Eye (Lond) 2009; 24:947-53. [PMID: 19942939 DOI: 10.1038/eye.2009.279] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The introduction of anti-metabolite regimens to glaucoma filtration surgery has improved post-operative intraocular pressure (IOP) control; however, it has also increased the frequency of dysfunctional blebs. In this study, we report a surgical technique for the repair of trabeculectomy blebs using bleb preservation, a sliding conjunctival flap, and fibrin glue. METHODS This study is a retrospective, non-comparative, consecutive case series involving 10 eye samples collected from 10 patients (6 M : 4 F) with one or a combination of bleb overfiltration, dysesthesia, thinning, leak, or blebitis, in which a conjunctival flap was advanced over the failing bleb and secured in place using fibrin glue and sutures. RESULTS All patient eyes had symptom resolution post-operatively. There were no bleb leaks or hypotonous eyes after an average follow-up of 15.2 months (range: 6-31 months). Three patients required needling augmented with 5-fluorouracil needling to maintain IOP control. IOP decreased from a mean of 13.6+/-1.8 mm Hg (with a mean of 0.7 glaucoma medications) pre-operatively to 11.7+/-0.9 mm Hg (with a mean of 0.9 glaucoma medications). CONCLUSION Conjunctival flap advancement with bleb preservation and adjunctive fibrin glue is a successful technique used for the treatment of bleb dysfunction. The major advantages compared with other techniques are preservation of IOP control and reduced post-operative complications, such as wound leak and the need for re-suturing.
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Affiliation(s)
- G A Lee
- City Eye Centre, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Abstract
Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.
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Affiliation(s)
- Anita Panda
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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