1. The Use of Fibrin Glue in Conjunctival Limbal Autograft Transplantation
Yonca Aydin Akova MD, Leyla Erkanli Asena MD
Baskent University Faculty of Medicine,
Department of Ophthalmology, Ankara, Turkey
The authors have no financial interest in the subject matter of this
poster
ASCRS Symposium on Cataract, IOL and Refractive Surgery 2011, March San Diego

2. Purpose
To report the results of conjunctival limbal autograft transplantation (CLAT) surgery using fibrin glue in 3 patients with limbal stem cell deficiency

3. Patients and Methods
3 eyes of 3 patients with limbal stem cell deficiency (LSCD)
2 patients with chemical (alkali) injury
1 patient following long term treatment for acanthamoeba keratitis
CLAT surgery using fibrin glue
Only few fixation sutures on the conjunctival side for ensuring graft stability
No sutures on the corneal side
The mean duration of postoperative follow-up
23,3 (18-30) weeks
Outcome variables
Pre- and postoperative best corrected visual acuities (BCVA)
Duration of the surgical procedure
Graft stability
Complications

4. Results Patient comfort was satisfactory
Decreased pain and inflammmation
No intra- or postoperative complications
The graft was stable in two patients
Minimal graft retraction in one patient due to vigorous eye-rubbing
The mean duration of the surgical procedure was 40,7 (34-48) minutes
Directly proportional to the time needed for superficial keratectomy
Visual acuity increased in all patients
Preoperative BCVA (Snellen)
Patient 1: 0.1
Patient 2: 0,3
Patient 3: 0,4
Postoperative BCVA (Snellen)
Patient 1: 0,8
Patient 2: 0,5 Patient 3: 0,7
Patient 2

5. Patient 1
Postoperative week 1
Postoperative month 2

6. Patient 3
Preoperative
Postoperative Day 1
Postoperative Week 1

7. Limbal Stem Cell Deficiency Etiology
Trauma
Chemical injury, thermal injury, recurrent surgery, long term contact lens wear
Inflammation
Stevens-Johnson Syndrome, Ocular Cicatricial Pemphigoid, severe microbial keratitis
Other
Aniridia, multiple endocrine neoplasia associated keratitis

8. Clinical Findings Therapy
Limbal Stem Cell Deficiency
Clinical Findings Therapy
Corneal surface irregularity
Punctate superficial flourescein staining- epithelial defects
Conjunctival epithelial cells migrating from the limbus to the central cornea “conjunctivalization”
Corneal neovascularisation
Chronic corneal inflammation, scarring and ulcer formation
Antiinflammatory agents
Topical and subconjunctival bevacizumab
Amniotic membrane transplantation
Penetrating keratoplasty combined with limbal stem cell transplantation
Unilateral cases- Conjunctival limbal autograft transplantation
Fibrin glue

9. Sutureless Conjunctival Limbal Autograft Transplantation with Fibrin Glue
Fibrin Glue Advantages:
Decreased duration of surgery
Better tissue apposition
Decreased risk for postoperative wound infections
Suture related infections↓
Antimicrobial activity of aprotinine (?)
Increased patient comfort
Fibrin Glue Disadvantages :
Allergic reactions due to aprotinine
Rare
Cost?
~132 $ per ml (one patient)
Panda A, Kumar S. et all. Indian J Ophthalmol 2009;57:
Chen Wl, Lin CT. et. all. Cornea 2007;26:

10. A rational alternative in the surgical treatment of LSCD
Conclusion
The use of fibrin glue in CLAT
Decreases the duration of the surgical procedure
Decreases the rate of suture related complications
Debris accumulation
Wound infection
Increased patient comfort
Preoperative
A rational alternative in the surgical treatment of LSCD
Postoperative