the use of fibrin glue in conjunctival limbal autograft transplantation
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The Use of Fibrin Glue in Conjunctival Limbal Autograft
Transplantation
The authors have no financial interest in the subject matter of this
poster
Yonca Aydin Akova MD, Leyla Erkanli Asena MD
Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
ASCRS Symposium on Cataract, IOL and Refractive Surgery 2011, March 25-29 San Diego
Purpose
• To report the results of conjunctival limbal autograft transplantation (CLAT) surgery using fibrin glue in 3 patients with limbal stem cell deficiency
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
Results
• 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
• 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
Preoperative BCVA (Snellen)
Patient 1: 0.1Patient 2: 0,3 Patient 3: 0,4
Postoperative BCVA (Snellen)Patient 1: 0,8Patient 2: 0,5 Patient 3: 0,7
Patient 2
Patient 1
• Postoperative week 1
• Postoperative month 2
Patient 3
• Postoperative Day 1 • Postoperative Week 1
• Preoperative
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
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
Limbal Stem Cell Deficiency
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 comfortFibrin Glue Disadvantages :• Allergic reactions due to aprotinine
– Rare• Cost?
– ~132 $ per ml (one patient)
Panda A, Kumar S. et all. Indian J Ophthalmol 2009;57:371-179 Chen Wl, Lin CT. et. all. Cornea 2007;26:1228-1234
ConclusionThe 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
Postoperative
A rational alternative in the surgical treatment of LSCD
Preoperative
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