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Fibrin glue-assisted glaucoma drainage device surgery.

Kahook MY, Noecker RJ

Department of Ophthalmology, University of Colorado Health Sciences Center, Rocky Mountain Lions Eye Institute, CO 80045, USA. Malik.kahook@gmail.com

AIM: To describe the use of fibrin glue as a suture substitute for portions of glaucoma drainage device (GDD) surgery. METHODS: Retrospective non-randomised case-control study reviewing 28 consecutive cases of GDD implantation using traditional suture material compared with 14 consecutive cases of GDD implantation using Tisseel fibrin glue (Baxter AG, Vienna, Austria) for portions of the procedure. The fibrin glue was used to close the conjunctiva, secure the pericardium patch graft and secure the tube to the sclera. Three-month follow-up data for each group as well as data on operating times, postoperative conjunctival inflammation, drugs used for glaucoma and intraocular pressure (IOP) were evaluated. Statistical analysis was carried out using analysis of variance. RESULTS: The mean (SD) age of the patients in the suture group (17 men and 11 women) was 56.6 (10.5) years and that in the Tisseel-assisted group (8 men and 6 women) was 54.7 (8.6) years (p = 0.56). No significant differences were observed in IOP levels at any time point between the two groups. No significant differences were found for the need for postoperative glaucoma drops or postoperative complication rates in both groups. Conjunctival inflammation was more pronounced in the suture group (p = 0.002) using a standard scale for comparison. The mean (SD) time of surgery was significantly less for the Tisseel-assisted group, 15.0 (3.11) min, than for the suture group, 25.93 (4.04) min (p<0.001). CONCLUSIONS: Tisseel fibrin glue seems to be a safe substitute for some of the sutures used in GDD surgery. Use of Tisseel seems to have no effect on IOP control or complications, whereas it considerably improved postoperative conjunctival inflammation and reduced time of surgery. Further studies are needed to better understand the role of fibrin glue in GDD implantation.

Published 20 November 2006 in Br J Ophthalmol, 90(12): 1486-9.
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