Dacryocystectomy: A fibrin glue-assisted subfascial excision

This article describes a technique of dacryocystectomy involving dissection within the subfascial plane, in which the lacrimal sac fascia is preserved and the orbital fat remains undisturbed. The lacrimal sac cavity was directly injected with Tisseel fibrin glue mixed with trypan blue. This led to sac distension and facilitated its separation from surrounding periosteal and fascial attachments. Staining the lacrimal sac epithelium improved definition of the mucosal lining. Transverse sections of the lacrimal sac specimen were histologically analyzed, which confirmed that dissection was completed within a subfascial plane. The technique herein described facilitates en bloc excision of the lacrimal sac without breaching the fascial plane that separates the sac from orbital fat.

A novel interlamellar oral mucosa graft surgery technique using fibrin glue for the treatment of trichiasis / Nova técnica cirúrgica de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase

ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>

RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.

Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Purpose: To assess the efficacy and clinical outcome of Tenon’s patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS?OCT) were performed on every follow?up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow?up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS?OCT is a valuable noninvasive tool for monitoring the graft status

Comparison conventional endoscopic myringoplasty with fibrin glue supplemented endoscopic myringoplasty

Introduction: The fibrin tissue glues have been used in many surgeries to reinforce surgical sutures and tissue adhesion. Myringoplasty is the commonly done ear surgery for the perforations of the tympanic membrane, where no suturing is done between remnant membrane and graft. Aim: The aim of the study is to compare the results and effectiveness of this biological fibrin tissue glue in myringoplasty surgeries as a supplementary procedure to conventional endoscopic myringoplasty (CEM) surgeries. Materials and Methods: Seventy patients with chronic suppurative otitis media with tympanic membrane perforation without ossicular and mastoid involvement have been chosen. One group of 35 patients underwent CEM surgeries. In another group of 35 patients, biological fibrin tissue glue, TISSEEL, has been used as supplementary to the CEM surgeries, and the graft uptake rate and hearing improvement were evaluated and compared postoperatively. Results: The graft success rate at 3 months postoperatively was 91.42% in both the groups, that is, 32/35, and these values were not statistically significantly different (P = 1.00). There was a highly statistically significant hearing outcome before and after the surgery in both the CEM and the fibrin tissue glue supplemented endoscopic myringoplasty groups. However, there was no statistically significant change in hearing outcomes between the two groups. Conclusion: In our study, we have got more or less similar results compared with the results of the studies on routine CEM cases. But the high-cost nature of the commercially available fibrin tissue glue makes it difficult to recommend for use in all routine endoscopy myringoplasty cases

Fibrin glue assisted amniotic membrane graft reconstruction of conjunctival fornix and canthus following excision of conjunctival tumours

Conjunctival tumors involving non?limbal locations, such as the fornix and canthus, are typically excised using a “non?touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.

A glued technique of external dacryocystorhinostomy

Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non?significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable

Morphometric study of rat sciatic nerve recovery after three nerve repair techniques: epineural suture, polyethylene glycol hydrogel and fibrin sealant / Estudio morfométrico de la recuperación del nervio ciático de rata después de tres técnicas de reparación nerviosa: sutura epineural, hidrogel de polietilenglicol y sellante de fibrina

SUMMARY: The effectiveness of microsurgical technique has a direct impact on the recovery of the injured peripheral nerve. The aim of our study was to investigate the result of sciatic nerve regeneration in rats after complete neurotomy and after nerve repair techniques including: 1) epineural suture; 2) polyethylene glycol hydrogel (PEG) (DuraSeal); 3) fibrin sealant (Tisseel). The cross-section of distal sciatic nerve was studied at 14th, 30th and 60th days after nerve repair. Morphometry of myelinated nerve fibers in the distal stump of the sciatic nerve was performed. A significant increase in the number of myelinated nerve fibers was found, especially between 14 and 30 days. The density of myelinated nerve fibers in the distal stump at day 60 was significantly higher after using nerve repair technique including PEG and fibrin versus epineural suture (29.2 % and 32.1 % versus 21.5 %, P <0.05), and a higher level of remyelination of nerve fibers observed in the group with PEG. On day 60, complete elimination of PEG and fibrin sealant was not observed, encapsulation was found around the clusters of hydrogel. Thereby, three peripheral nerve repair techniques were equally effective, only with the use of PEG remyelination of nerve fibers was increasing.

RESUMEN: La efectividad de la técnica microquirúrgica tiene un impacto directo en la recuperación del nervio periférico lesionado. El objetivo de nuestro estudio fue investigar el resultado de la regeneración del nervio ciático en ratas después de una neurotomía completa y después de técnicas de reparación nerviosa que incluyeron: 1) sutura epineural; 2) hidrogel de polietilenglicol (PEG) (DuraSeal); 3) sellante de fibrina (Tisseel). La sección transversal del nervio ciático distal se estudió a los 14, 30 y 60 días después de la reparación del nervio. Se realizó la morfometría de fibras nerviosas mielinizadas en el muñón distal del nervio ciático. Se observó un aumento significativo en el número de fibras nerviosas mielinizadas, especialmente entre los 14 y 30 días. La densidad de las fibras nerviosas mielinizadas en el muñón distal en el día 60 fue significativamente mayor después de usar una técnica de reparación nerviosa que incluye PEG y fibrina en comparación con la sutura epineural (29,2 % y 32,1 % versus 21,5 %, P <0,05), y un mayor nivel de remielinización del nervio en fibras observadas en el grupo con PEG. El día 60, no se observó la eliminación completa de PEG y sellador de fibrina, se encontró encapsulación alrededor de los grupos de hidrogel. Por lo tanto, tres técnicas de reparación de nervios periféricos fueron igualmente efectivas, solo que aumentaba la remielinización de fibras nerviosas con PEG.

A Comparative Study To Evaluate The Outcome Of Sutures Versus Fibrin Glue In Conjunctival Autograft Technique For Primary Pterygium Excision

Background:Pterygium is degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue and is characterized by formation of a triangular fold of conjunctiva encroaching on the cornea leading to visual impairment, restriction of ocular motility, chronic in?ammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Now, Fibrin glue is being tried since few years to secure grafts in place of the sutures. The objective of this study was to compare duration of surgery, immediate postoperative complications which includes an in?ammation, subconjunctival haemorrhage, patient comfort, graft stability between the uses of ?brin glue versus sutures. Methods:A total of 40 patients having primary pterygium were included in the study. 20 patients were underwent pterygium excision surgery and conjunctival autografting using absorbable vicryl 8-0 suture and 20 patients underwent pterygium excision surgery and conjunctival autografting using ?brin glue. These 2 groups were compared in terms of duration of the surgery, in?ammation, degree of postoperative discomfort, subconjunctival haemorrhage and graft stability at postoperative day 1. Results:The mean surgery time in ?brin glue group was 15 minutes and mean surgery time in suture group was 28 minutes (p=0.000). Fibrin glue group had signi?cantly lesser in?ammation (p=0.001) as well as postoperative discomfort (p=0.000) compared to suture group at postoperative day 1. There was no signi?cant difference found in the degree of subconjunctival haemorrhage between the ?brin glue versus sutures groups (p=0.887 and p=0.797 at day 1). The grafts secured with ?brin glue were as stable as those secured with the sutures (p=0.745, 0.644 at day 1). Conclusion:The ?brin glue group in conjunctival autografting had signi?cantly less surgery time, which also produces signi?cantly less postoperative discomfort as well as in?ammation with grafts being as stable as those secured with sutures. Fibrin glue can be used regularly if patients can be pooled together and operated on, by making it cost effective procedure

Tratamento de crescimento epitelial persistente pós-Lasik com debridamento mecânico, uso de álcool a 20% e cola de fibrina / Treatment of persistent epithelial ingrowth after Lasik with mechanical debridement, use of 20% alcohol and fibrin glue

RESUMO O Lasik é a técnica de cirurgia refrativa mais utilizada no mundo. Apesar de segura e efetiva, ela pode levar a algumas complicações. O crescimento epitelial pós-Lasik é uma complicação pós-operatória incomum, com prevalência maior em casos de retratamento. Geralmente, é um achado não progressivo e assintomático, que não requer tratamento, mas, em uma minoria de pacientes, os sintomas podem ser clinicamente significantes e variados. O tratamento é feito com debridamento mecânico do crescimento epitelial, mas alguns recursos adjuvantes também podem ser utilizados. O presente estudo consiste em um relato de caso de paciente com crescimento epitelial pós-Lasik que apresentou quatro recidivas após intervenções de debridamento epitelial, sutura de lamela corneana e ablação a laser. No quinto procedimento, o paciente foi finalmente tratado com combinação de debridamento epitelial, uso de álcool a 20% e cola de fibrina. Entretanto, a regressão do crescimento epitelial e a melhora da acuidade visual só ocorreram ao longo dos meses após a intervenção, o que mostra a importância de esperar um tempo para que ocorra a melhora da visão no pós-operatório, evitando-se reintervenções.

ABSTRACT Lasik is the most often performed laser refractive surgery worldwide. Despite its efficacy and safety, some complications may occur. Epithelial ingrowth is a rare postoperative complication of Lasik, with an increased prevalence in cases of retreatment. Epithelial ingrowth is usually a nonprogressive and asymptomatic finding, which requires no treatment; however, in a minority of cases, symptoms may be clinically significant and diverse. Treatment is done with mechanical debridement of the affected interface, and additional interventions may be required. This study reported a case of recalcitrant epithelial ingrowth after Lasik, whichrelapsed four times after mechanical debridement, flap lift and laser ablation. In the fifth intervention, the patient was finally treated with a combined scraping/use of 20% alcohol and fibrin glue. However, regression of epithelial ingrowth and better visual acuity were only observed some months after the intervention, which shows the importance of waiting for better vision in the postoperative period, thus avoiding new reinterventions.

Effects of human-derived fibrin glue for preventing postoperative complications of endoscopic submucosal dissection for esophageal lesions / 中华消化内镜杂志

Objective:To explore the effects of human-derived fibrin glue on prevention of postoperative complications of endoscopic submucosal dissection (ESD) in early esophageal squamous cancer and precancerous lesions.Methods:A total of 210 patients with early esophageal squamous cancer or precancerous lesions who underwent ESD at Department of Gastroenterology, Zhongda Hospital Affiliated to Southeast University from April 2017 to April 2020 were included in this retrospective study. Seventy-three cases (79 esophageal lesions) where human-derived fibrin glue was used before retrieving endoscope were included in the observation group, while 137 cases (156 esophageal lesions) where fibrin glue was not used were included in the control group. The postoperative complications and pain were compared between the two groups.Results:Clinical data including general information, longitudinal length, Paris type, pathological type, invasion depth, circumferential range, area of resection, duration of operation and local steroid used were similar between the two groups ( P>0.05). The incidences of perforation, delayed bleeding and esophageal stenosis in the observation group were 2.7% (2/73), 1.4% (1/73), and 16.4% (12/73), respectively, and were 2.9% (4/137), 1.5% (2/137), and 13.1% (18/137), respectively in the control group. There were no significant differences between the two groups ( P>0.05). The incidence of postoperative pain in the observation group was 53.4% (39/73), which was significantly lower than that in the control group of 70.8% (97/137) ( χ2=6.302, P=0.012). The incidences of mild, moderate and severe pain in observation group on the day of ESD were 9.6% (7/73), 6.8% (5/73) and 5.5% (4/73), respectively, and 27.0% (37/137, χ2=8.724, P=0.003), 17.5% (24/137, χ2=4.554, P=0.033) and 0.7% (1/137, χ2=2.805, P=0.094), respectively in the control group. The incidences of mild, moderate and severe pain in the observation group on the first day after the operation were 26.0% (19/73), 5.5% (4/73) and 6.8% (5/73), respectively, and 29.2% (40/137, χ2=0.237, P=0.626), 14.6% (20/137, χ2=3.912, P=0.048) and 4.4% (6/137, χ2=0.193, P=0.660), respectively in the control group. The corresponding incidences on the second day after the operation were 5.5% (4/73), 0 and 1.4% (1/73) in the observation group and 19.0% (26/137, χ2=7.087, P=0.008), 2.9% (4/137) and 0 in the control group, respectively. Conclusion:Human-derived fibrin glue shows no obvious preventive effect on post-ESD bleeding, perforation or stenosis in early esophageal cancer and precancerous lesions. However, it can significantly reduce the incidence of ESD-related postoperative pain, especially the incidences of mild and moderate pain.

Effect of thrombin concentration on the prevention of postoperative cerebrospinal leakage by fibrin glue / 中国组织工程研究

BACKGROUND: Fibrin glue is commonly used to prevent postoperative cerebrospinal fluid leakage from dural injuries. However, fibrin glue with standard-concentration thrombin coagulates too fast, resulting in poor adhesion of dural mater. Effect of low-concentration thrombin fibrin glue on sealing dural injuries to prevent cerebrospinal fluid leakage is unclear. OBJECTIVE: To compare the effect of low-concentration thrombin and standard-concentration thrombin on the prevention of cerebrospinal fluid leakage from dural injuries by fibrin glue. METHODS: Forty patients including 25 males and 15 females with dural injuries admitted at Fifth People’s Hospital of Chengdu from May 2017 to December 2019 were enrolled. Patients were randomly divided into two groups, 20 patients in each group. In low-concentration thrombin group, dural injuries were sealed with fibrin glue prepared with low-concentration thrombin solution (100 IU/mL). In standard-concentration thrombin group, dural injuries were sealed with fibrin glue prepared with standard-concentration thrombin solution (500 IU/mL). All patients were followed up for 2 months. The incidence of cerebrospinal fluid leakage, cumulative drainage flow, drainage duration and incision complications were compared between the two groups. The study was approved by Ethics Committee of Fifth People’s Hospital of Chengdu. RESULTS AND CONCLUSION: (1) The incidence of cerebrospinal leakage, accumulative volume and duration of drainage in the low-concentration thrombin group were lower than those of standard-concentration thrombin group (P 0.05). (3) These results indicate that fibrin glue prepared with low-concentration thrombin solution decreases the rate of cerebrospinal leakage, reduces the drainage volume and shortens the duration of drainage, which is demonstrated to be an effective strategy for sealing dural injuries.

Safety of drainless excision of the submandibular gland / Segurança na excisão da glândula submandibular sem o uso de drenos

Abstract Introduction: Percutaneous drains can be associated with several complications, including infection, fistula formation, discomfort and prolonged hospitalization. Objective: The aim of this study was to evaluate the safety of submandibular gland excision without the use of surgical drains. Methods: We analyzed the surgery time, postoperative complications such as bleeding, facial palsy, seroma, and repeat exploration of wounds and duration of the hospital stay. Excision of the submandibular gland via a transcervical approach was undertaken by two surgeons. Prior to wound closure, the skin flap and wound bed were approximated using hemostatic fibrin glue (Greenplast-Q PFS KIT®, GC Greencross, Youngin, Korea). Neither saline irrigation nor insertion of a percutaneous drain were included. Results: A total of 23 patients underwent submandibular gland excision. The study group consisted of 14 men (60.8%) and 9 women (39.2%) (mean age, 47.6 years; range, 24-70 years). There were two patients who had minor complications. One patient showed minor bleeding on the skin incision line immediately postoperatively, and one developed a seroma at 7 days postoperatively. There were no major surgical complications. Total duration of the surgery from skin incision to closure averaged 44.86 minutes. Mean duration of the hospital stay was 3.17 days. Patients were discharged on average at 1.17 days after surgery. Conclusion: The submandibular gland can be safely excised without the use of a surgical drain, therefore allowing early patient discharge.

Resumo Introdução: Os drenos percutâneos apresentam várias complicações associadas, inclusive infecção, formação de fístulas, desconforto e permanência hospitalar prolongada. Objetivo: Avaliar a segurança da excisão da glândula submandibular sem o uso de drenos cirúrgicos. Método: Analisamos o tempo de cirurgia, as complicações pós-operatórias tais como sangramento, paralisia facial, seroma e necessidade de reexploração de ferida operatória, e a duração da internação hospitalar. A excisão da glândula submandibular por via transcervical foi realizada por dois cirurgiões. Antes do fechamento da incisão, o retalho cutâneo e o leito da ferida operatória foram aproximados utilizando cola hemostática de fibrina (Greenplast-Q PFS KIT®, GC Greencross, Youngin, República da Coréia). Não houve irrigação salina nem uso de dreno percutâneo. Resultados: Foram submetidos 23 pacientes à excisão da glândula submandibular. O grupo de estudo consistiu em 14 homens (60,8%) e 9 mulheres (39,2%) (média de 47,6 anos; variação de 24 a 70). Dois pacientes apresentaram complicações menores. Um paciente apresentou pequeno sangramento na incisão da pele no pós-operatório imediato e um deles teve seroma aos 7 dias de pós-operatório. Não houve complicações cirúrgicas importantes. A duração total da cirurgia, desde a incisão na pele até o fechamento, foi de 44,86 minutos. A duração média da internação hospitalar foi de 3,17 dias. Os pacientes receberam alta em média 1,17 dia após a cirurgia. Conclusão: A glândula submandibular pode ser excisada com segurança sem o uso de dreno cirúrgico, permitindo que o paciente tenha alta hospitalar mais precocemente.

Safety and efficacy of glued intraocular lens implantation in eyes with inadequate capsular support

Background: Aim of the study was to analyze the postoperative visual outcomes, complication rate of fibrin glue-assisted, suture-less posterior chamber (PC) intraocular lens (IOL) implantation technique in eyes with inadequate capsule support at a tertiary eye care hospital.Methods: This is a retrospective, nonrandomized case series. This study analyzes 50 eyes which underwent PC-IOL implantation by fibrin glue-assisted, suture-less technique. All patients who had IOL implants by the fibrin glue-assisted PC-IOL technique from 2017 to 2019 were included in the study. Intra- and post-operative complications were analyzed. The postoperative best corrected visual acuity (BCVA) was evaluated and recorded at the end of 6 months.Results: Mean age of distribution are 42.94 years in glued IOL implantation. Among 50 cases 30 are males and 20 are females. There is significant difference in BCVA between preoperatively and postoperatively, p value for pre-operative to post-operative vision in glued intraocular lens group is <0.0001 i.e. there is definite improvement in vision  in glued intraocular group. BCVA ≥6/24 was 18 (48%) in Glued IOL subjects.Conclusions: Glued IOL implantation is a feasible option in rehabilitating patients with aphakia without adequate capsular support.

Sonic hedgehog-polydopamine-fibrin scaffold promotes recovery of spinal cord injury in rats / 中国组织工程研究

BACKGROUND: Recently, most studies have combined tissue engineering materials with stem cells or factors to improve the microenvironment of animal models of spinal cord injury to increase the duration of action, improve the recovery effect and prognosis. OBJECTIVE: To investigate the effect of sonic hedgehog-polydopamine-fibrin scaffold on the repair of spinal cord injury in rats. METHODS: Fibrin glue was made using a vacuum freeze-dryer. The prepared fibrin glue was immersed in a dopamine hydrochloride solution for 24 hours for cross-linking. Then the cross-linked scaffold was placed in a factor solution for adsorption and cross-linking for 24 hours. Sonic hedgehog-polydopamine-fibrin scaffolds were prepared. Sixty female SD rat models of spinal cord injury were established and then divided into four groups: In the group A, no material was implanted. In the groups B, C and D, fibrin scaffolds, polydopamine-fibrin scaffolds, and sonic hedgehog-polydopamine-fibrin scaffolds were implanted respectively. The Basso, Beattie and Bresnahan (BBB) locomotor scale score of lower limb locomotor function was evaluated within 12 weeks after surgery. At 12 weeks post-surgery, the tissue at the site of spinal cord injury was collected for histological observation (hematoxylin-eosin and immunohistochemical staining) and western blot assay. This study was approved by the Animal Ethics Committee of Jiangsu University, China. RESULTS AND CONCLUSION: (1) From 2 weeks after surgery, the lower limb locomotor function of rats in each group began to recovery. At 5-12 weeks after surgery, the BBB score of group D was significantly higher than that of the other three groups (P < 0.05). Rats in group D had the best recovery of locomotor function of the lower limb. (2) Hematoxylin-eosin staining revealed newly generated nerve fibers in the groups C and D, and that the number of density of new nerve fibers in group C was lower than that in group D. (3) Immunohistochemical staining showed that a large amount of linearly arranged new nerve fibers were observed in the completely transected site of rat spinal cord. In group D, myelin basic protein-, growth related protein- and neurofilament protein-positive rates were significantly higher (P < 0.05), and glial fibrillary acidic protein-positive rate was significantly lower, compared with the other three groups. (4) Western blot assay revealed that in group D, the protein expression of myelin basic protein, growth related protein and neurofilament protein was significantly higher (P < 0.05), and the protein expression of glial fibrillary acidic protein was significantly lower (P < 0.05), compared with the other three groups. (5) These results suggest that sonic hedgehog-polydopamine-fibrin has a good sustained-release performance, which can greatly promote the repair of spinal cord injury in rats.

Clinical effect of pterygium excision combined with fresh amniotic membrane transplantation using human fibrin glue with sutureless / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the clinical effect of human fibrin glue in pterygium excision combined with fresh amniotic membrane transplantation and its clinical value. <p>METHODS: This study was a prospective analysis of 153 pterygium excision patients(153 cases, 153 eyes)from March 2018-October 2018. The patients were randomly and evenly divided into two groups: observation group(78 eyes)and control group(75 eyes). In fibrin glue group, patients(78 eyes)underwent pterygium excision, and the bare selera was covered with fresh amniotic membrane using fibrin glue for graft adherence, while in suture group, patients(75 eyes), the an amaiotic membrane grafts was attached to the selera using 10-0 nylon sutures after pterygium excision. Record the surgical time and the degree of pain after surgery were evaluated at 2h, 1, 3, 5 and 10d(before sutures out)after surgery. <p>RESULTS: Average surgical time(14.5±3.6)min in fibrin glue group was significantly less than suture group(18.3±4.2)min(<i>P</i><0.05). The scores of 2h and 1, 3, 5 and 10d(before thread removal)pain levels were statistically significant(<i>F</i>=39.939, 419.026, 28.410, all <i>P</i><0.01). After surgery, the degree of pain of treatment group was significantly decreased compared to control group, the difference was statistically significant(<i>P</i><0.01). There were significant differences in pain scores at different time points in each group(<i>P</i><0.01). There were no significant differences in the 2 groups comparing treatment outcomes of the recurrence rate at the end of 12-month follow-up(<i>P</i>>0.05).<p>CONCLUSION: It not only significantly reduces the surgical time, but also minimizes postoperative discomfort when we use fibrin glue in pterygium excisions. But it cannot decrease the recurrence rate.

A Retrospective Study of Microporous Polysaccharide Hemostatic Powder Combined with Other Repair Materials for Reducing Postoperative Pulmonary Air Leakage during Pulmonary Segmentectomy / 中国肺癌杂志

BACKGROUND@#Anatomical segmentectomy is more and more widely used in lung nodules and early stage lung cancer. Postoperative lung air leakage is one of the common complications after surgery. This study aimed to explore the effect of the application of repair materials in precise segmentectomy under thoracoscopy in reducing postoperative lung air leakage.@*METHODS@#This study included patients admitted to the Department of Thoracic Surgery of Jiangsu Provincial People's Hospital who were scheduled to undergo thoracoscopic segmentectomy from August 1, 2018 to July 31, 2019. According to the difference of the materials used in the treatment of the inter-segment interface during the operation: patients who used microporous polysaccharide hemostatic powder+fibrin adhesive glue+absorbable polyglycolic acid patch were divided into group A, and the patients with fibrin adhesive+absorbable polyglycolic acid patch were divided into group B. The preoperative basic information of all patients and the daily postoperative chest drainage volume, the indwelling time of the chest drainage tube, the chest radiograph before the chest drainage tube is removed, the chest radiograph after the chest drainage tube is removed, blood routine and postoperative hospital stay were collected and recorded, and the effect of the application of intraoperative repair materials on postoperative lung air leakage was analyzed.@*RESULTS@#There were statistically significant differences in the indwelling time of thoracic drainage tube (P=0.019) and postoperative hospital stay (P=0.017) between the two groups.@*CONCLUSIONS@#Compared with the use of the fibrin glue+absorbability polyglycolic acid patch, the use of microporous polysaccharide hemostatic powder+fibrin glue+absorbability polyglycolic acid patch in the treatment of the inter-segment interface during segmentectomy can better reduce the incidence of postoperative air leakage and shorten the postoperative hospital stay.

Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): A novel surgical technique for closing retinal breaks

Purpose: This study describes a novel surgical technique of fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD) without oil or gas tamponade after pars plana vitrectomy (PPV). Methods: This pilot clinical trial included five eyes of five patients with rhegmatogenous retinal detachments (RD). A complete PPV was done in all cases followed by fluid–air exchange, laser photocoagulation around the break/s, and application of 0.1–0.2 mL of fibrin glue. No air, long-acting gas or silicone oil was used subsequently. No specific postoperative positioning was prescribed. The primary outcome measure was efficacy of the procedure defined as successful anatomical retinal reattachment. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) and complications. Results: The median age of patients was 55 (range: 36–61 years) years and median duration of symptoms was 15 (range: 7–60) days. All eyes were pseudophakic, four eyes had inferior and one eye had total RD. Successful retinal reattachment was achieved in all (100%) cases and was maintained at the end of 3–8 months of follow-up. The median BCVA improved from 20/100 preoperatively to 20/80 at 1-week and 20/50 at 1-month postoperatively. None of the eyes had any postoperative complications such as elevated intraocular pressures or unexpected inflammation. Conclusion: The findings of this study suggest that GuARD is a promising technique for treatment of rhegmatogenous RD that may allow early visual recovery while avoiding the problems of gas or oil tamponade and obviating the need of postoperative positioning.

Sutureless, Glue-Free Conjunctival-Limbal Autograft In The Management Of Primary Pterygium

Background: Pterygium is a triangular wing shaped fiovascular growth of subconjunctival tissue on to the cornea. Surgical removal is the treatment of choice but no single technique is successful due to high recurrence rate. Aim: To evaluate the success and complications of sutureless glue–free conjunctival–limbal autografting in management of primary pterygium. Materials and Methods: A prospective interventional study was carried out in 60 patients to analyse the outcome of sutureless and glue–free conjunctival–limbal autograft for the management of primary nasal pterygium. The patients were followed up after 1 week, 3 weeks, 6 weeks and at 3 months postoperatively. The mean age of the patients was 38.28± 13.77 years (range 21–67), 55% of which were females. Graft retraction occurred in 3(5%) eyes. Haemorrhage was seen in 20(33.33%) eyes at 24 hours, which persisted in only 8(13.33%) eyes at 3 weeks and resolved completely in 100% of eyes at 6 weeks. Oedema was noted in 5(8.33%) eyes at 24 hours, and resolved completely by 1 week. Recurrence of pterygium was observed in 2(3.33%) eyes at three months of follow–up. Conclusion: Sutureless and glue–free conjunctival–limbal autograft following pterygium excision is an easy, quick, safe, effective, and economical option for the management of primary pterygium.

Fibrin Glue Injection a Promising Option in the Treatment of Patients with Anal Fistula

Background: Fistula in ano is a public perianal illness and as a long-lasting inflammatory illness which does not cure naturally. There are several surgical procedures for treatment of fistula in ano, but these surgical interventions have little degrees of success, long time of wound healing after surgery and prolonged pain, especially in complex and difficult fistulas are observed. Novel sphincter-saving methods have been used in the management of perianal fistula in order to evade the risk of fecal incontinence. Among them, the fibrin adhesive method is popular because of its ease and repeatability. Objective: The objective of the present study is to evaluate the effect of fibrin-glue injection in the treatment of anal fistula (low/high as well as primary/secondary). Method: A prospective, planned experiment was conducted on 322 patients who were established to have fistulas in ano. They were assessed by sorting them into high fistula (172/322) and low anal fistula type (150/322). The fibrin glue was instilled in their anal tracts. The character of the anal tract, whether it was simple or complex and primary or secondary, was analyzed. The outcome in terms of a postoperative discharge (failure) was noted at 3 months, 6 months, 9 months, 1 year, and 2 years. Results: Total 322 patients were involved in this study. The general success rate was 275/322 (85.4%) after a mean follow-up of 1.5 years. All patients with a complex fistula (for low/high fistula, primary/secondary) had failure of healing (success rate 0%) either through first or second injection of fibrin-glue while all patients with simple fistula had successive rate of healing (for low/high fistula, primary/secondary) either through first or need the second injection of fibrin-glue. None of the patients had postoperative continence problems, and no other complications were noted. Conclusion: Fibrin glue is a novel attractive approach, easy, safe, minimally invasive, repeatable and cost effective for treatment of anal fistula simple (low/high and primary/secondary) and promising option for treatment of high fistula, and do not have a role for healing the complex anal fistula.

Progress in surgical techniques for scleral fixation of intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#Patients with traumatic or congenital disease lead to lens dislocation and posterior capsule rupture after cataract surgery, <i>etc</i>, which cannot be routinely implanted with intraocular lens, can be implanted with different intraocular lenses according to the condition. This article will introduce a variety of surgical methods for posterior chamber intraocular lens scleral fixation, including sutured scleral fixation, sutureless intrascleral fixation and Fibrin glue-assisted sutureless haptic intrascleral fixation. In addition, the postoperative results and complications of the above procedures will be reported and analyzed.