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.
ABSTRACT
PURPOSE: To report technique preferences for intravitreal injections among retina specialists in Mexico. METHODS: Cross-sectional survey. Ophthalmologists with a two-year retina training, active members of the Mexican Retina Association, were contacted through email to answer a survey consisting of 37 items regarding their IVI application technique. RESULTS: A total of 133 retina specialists participated, with a response rate of 78%. Forty-five percent applied the intravitreal injections in an operating room designated for the procedure. Sixty-three percent reported never injecting both eyes on the same day. Ninety-six percent wore a face mask during the procedure and 91% wore gloves. Eighty-two percent used a lid speculum. Tetracaine drops were the anesthetic method employed by 97% of participants. All participants utilized povidone-iodine for antisepsis. Eighty percent measured the puncture site with a caliper. Superotemporal quadrant was the one chosen to place the injection by 63% of participants. Fifty-nine percent indicated post-injection antibiotic drops for several days. Post-injection counting fingers visual acuity was verified by 53% of the participants. Fifty-six percent of the participants placed an eye-patch after the procedure. CONCLUSION: There are different practices regarding the application of intravitreal injections among retina specialists in Mexico. Performing this type of survey periodically could show changes in preferences, as new evidence is incorporated into clinical practice.
