1. Use of fibrin glue in ocular surgery
Diane Marinho, Melissa M. Dal Pizzol, Sérgio Kwitko, Samuel Rymer
Hospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - Brazil
The authors have no financial interest in the subject matter of this poster

2. Use of fibrin glue in ocular surgery
Human fibrin adhesives have become increasingly popular adjuncts to various ophthalmic surgeries. They are biodegradable into nontoxic metabolites. Some advantages are that the surgery is faster with improved hemostasis, with less postoperative discomfort and inflammation.1,2
Purpose:
To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries
Uy HS, et al. Compararison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmol 2005;112(4):
Kaufman HE, et al. Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion. Ophthalmol 2003; 110:

3. Methods: Retrospective and non-comparative study of 219 eyes.
Use of fibrin glue in ocular surgery
Methods:
Retrospective and non-comparative study of 219 eyes.
Fibrin glue (Beriplast P®, Aventis-Behring, Germany) was used in all patients for tissue adherence or incision closure (Table 1).
Surgeries performed were:
- autologous conjunctival transplantation (ACT) in 46.1%
- amniotic membrane transplantation (AMT) in 35,6%
- autologous limbal conjunctival transplantation (ALCT) in 4.1% (Figure 1)
- alogenic limbal transplantation (ALT) in 0,9%
- Descemet´s membrane microperforation sealing in deep lamellar anterior keratoplasty (DALK) in 3,6%
- clear corneal phacoemulsification incision in 2.3%
- conjunctival closure of trabeculectomy in 2.3%
- ALCT associated with AMT in 5%.

4. Use of fibrin glue in ocular surgery
Figure 1. Intraoperative use of fibrin glue to attach ALCT after pterygium excision (A) and same patient 15 days after the surgery (B). B A

5. Effective adherence of tissue was obtained in 95.4% of eyes.
Use of fibrin glue in ocular surgery
Results:
Effective adherence of tissue was obtained in 95.4% of eyes.
Detachment of the graft occurred in 10 cases (7 in AMT for bullous keratopathy, 2 in ACT for pterygium surgery, and one in ALCT in Stevens-Johnson Syndrome).
Granulomatous foreign body reaction developed in 9 eyes (5 in AMT for acute alkali injury, one in ALT for a chronic burn injury, and 3 in ACT in pterygium surgery).
Fail to seal Descemet´s membrane perforation during DALK was noted in two eyes (Table 2).

6. Use of fibrin glue in ocular surgery
Table 1
Underlying disease
ACT
AMT
ACT+ AMT
ALCT
ALT
Microperforation sealing
Closure of clear corneal phacoemulsification incision
Conjunctival closure of trabeculectomy
Total
Pterygium 94 11
105
Superior Limbic Keratoconjunctivitis 5 1 6
Limbal tumor 2 4
Conjunctivochalasis 25
Bullous Keratopathy 35
Limbal deficiency 7
Alkali burn 10 12
Stevens-Johnson Syndrome
Cataract
Glaucoma
DALK 8
Trophic ulcer
101 78 9
219
ACT: Autologous conjunctival transplantation
AMT: Amniotic membrane transplantation
ALCT: Autologous limbal conjunctival transplantation
ALT: Allogenic limbal transplantation
DALK: Deep anterior lamellar keratoplasty

7. Use of fibrin glue in ocular surgery
Table 2. Postoperative complications
Chemosis
Granuloma
Hyperemia
Dellen
Failed closure
Detachment
Autologous conjunctival transplantation 6 3 2 1
Amniotic membrane transplantation 5
Autologous conjunctival transplantation and amniotic membrane transplantation
Autologous limbal conjunctival transplantation
Closure of clear corneal phacoemulsification incision
Conjunctival closure of trabeculectomy
Microperforation sealing for DALK
Allogenic limbal transplantation
Total (n=219)
7 (3.2%)
9 (4.1%)
2 (0.9%)
1 (0.4%)
10 (4.5%)

8. Use of fibrin glue in ocular surgery
Conclusion:
Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation and incision closure, with low rates of complications in ocular surface and anterior segment surgeries.