Applications of Biological Tissue Adhesive in Ophthalmology

Abstract

Suturing is a time consuming task in ophthalmology also postoperative suture related complications make surgeons to think to switch to sutureless surgery using tissue adhesive (fibrin glue). Fibrin glue mimics the normal coagulation cascade occurs in human body resulting in its adhesive capability. Numerous techniques have been used to prepare fibrin glue, either from homologous or autologous plasma. The two components of fibrin glue can either be applied simultaneously or sequentially, depending on the surgeons preference. Advantages of fibrin glue include; Reduces the surgical time and lower the risk of post-operative wound infection. Well tolerated, non-toxic to the tissue and also useful in controlling bleeding in selected surgical patients. The major drawback to its use is the risk of transmitted diseases from pooled and single-donor blood donors. Applications of fibrin glue: Use of fibrin glue in corneal surgery Corneal perforation Fibrin glue is effective in the closure of corneal perforations up to 2 mm in diameter. Amniotic membrane transplantation Fibrin glue-assisted augmented AMT can be used for treatment of corneal perforations more than 2 mm in greatest dimension. Pirouzian A. et al reported a surgical technique for excising pediatric corneal limbal dermoid and post-resection ocular surface reconstruction by sutureless multilayered AMT using fibrin glue. Lamellar keratoplasty Fibrin glue-assisted sutureless lamellar keratoplasty is effective in patients with corneal ulcer. It also aids in subsequent manipulation in DMEK by decreasing the property of DM to scroll. Deep anterior lamellar keratoplasy Fibrin glue is a viable option to seal microperforations in DM during DALK and can be used to attach the corneal button in DALK without the use of sutures. Penetrating keratoplasty The use of fibrin glue in Top Hat PKP was found to be more mechanically stable than traditional sutures. Limbal cell transplantation Fibrin glue can be used for securing limbal grafts to the recipient eye in cases of limbal stem cell deficiency. Temporary keratoprosthesis Fibrin sealant stabilizes the keratoprosthesis without significant leakage and enables greater surgical control during VRS. Use of fibrin glue in refractive surgery Treatment of epithelial ingrowth Fibrin glue has been used to prevent epithelial ingrowth by functioning as a mechanical barrier. Fibrin glue as a temporary basement membrane In PRK autologous fibrin could be used immediately after surgery to work as a temporary basal membrane. Use of fibrin glue in treatment of lasik flap tear and dislocation Fibrin glue has been used to prevent potential flap dislocation. However, some surgeons do not hold great hope for this application. However, when it comes to flap tears, fibrin glue is much more encouraged. Use of fibrin glue in lens surgery Glued IOL Fibrin glue can be used for implantation of posterior chamber scleral fixated IOL without sutures. Sealing corneal incision Fibrin glue creates a watertight seal to cataract incisions. Prevention of postoperative astigmatism Postoperative against-the-rule astigmatism can be prevented with fibrin glue. Use of fibrin glue in glaucoma surgery Conjunctival closure Fibrin glue is a safe and efficient option for conjunctival closure in trabeculectomy. Management of postoperative leaking bleb Fibrin glue can be used in trabeculectomy to manage leaks and hypotony. Subconjunctival application of fibrin sealant is effective for temporary closure of the scleral flap after trabeculectomy in eyes with massive hypotony syndrome. Glaucoma drainage device surgery Fibrin glue can be used to close the conjunctiva, secure the patch graft and secure the tube to the sclera. Use of fibrin glue in lid and lacrimal surgery Lid surgery Fibrin glue used to attach a full-thickness skin graft during cicatricial ectropion repair. Fibrin glue and minimal suture technique is an alternative to eyelid incision closure with suture in blepharoplasty surgery. It is also helpful in lid split procedure combined with free skin graft for upper eyelid entropion. In lower eyelid trichiasis, glue has been used for fixation of free autologous conjunctival transplants in the lid split technique. Lacrimal surgery Fibrin glue has been used for reconstructing lacerated canaliculi, canaliculodacryocystorhinostomy, microanastomosis between canaliculi and lacrimal sac and for attaching lacrimal and nasal mucosal flaps. It also can be used as an injection treatment of lacrimal punctum in treatment of patients with dry eye. Use of fibrin glue in conjunctival surgery Fibrin glue is effective in conjunctival resection of CCH. Doss et al. explain the Paste-pinch-cut conjunctivoplasty using fibrin sealant injection subconjunctivally. It also has been used as an adhesive to keep the Gundersen flap in place.