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J. Shen, R. Robinson, M. Feurtado, K. M. Joos; Free Electron Laser-Treated Tisseel Enhances Closure of Trabeculectomy Leaks. Invest. Ophthalmol. Vis. Sci. 2007;48(13):832.
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The free electron laser (FEL) at Amide Band III wavelength (7.7 µm) has been shown to enhance tissue glue (Tisseel) congealment and adherence. This project evaluates FEL (7.7 µm) enhanced congealment of tisseel combined with subconjunctival injection of fibroblasts to seal trabeculectomy leaks.
A trabeculectomy was performed OD with a 1.5 mm leaking hole created in the bleb in 13 pigs. Tisseel was applied in and over the wound with 50% randomized to 7.7 µm FEL irradiation (30 Hz, 370 µm diameter spot size, 2 mJ). CoSeal surgical sealant was then applied, and 500,000 YFP-transfected porcine fibroblasts were injected subconjunctivally. Intraocular pressure (IOP) was measured before and after the procedure. Two days later, the procedure was repeated OS and the bleb OD was inspected prior to euthanasia and enucleation. The globes were examined with a fluorescent dissecting microscope, and the tissues processed for histology.
Mean IOP were 19+3.3 mmHg preoperatively , 6+2 mmHg immediately postoperatively, and 8+3.8 mmHg 2 days postoperatively. The materials coated all bleb holes acutely. No holes leaked on postoperative day 2. However, 75% of the non FEL-treated blebs compared to 30% of the FEL-treated blebs had only a thin covering over the hole. YFP-labeled fibroblasts were observed subconjunctivally in both acute and postoperative day 2 eyes. Histologically, Tisseel was observed to cover the holes in the acute eyes.
In a porcine model of trabeculectomy bleb holes, more complete healing occurred with low 7.7 µm FEL energy irradiation of Tisseal. YFP-labeled fibroblasts remained present at postoperative day 2 with future work planned to investigate whether they will increase the underlying cellular support in ischemic leaking blebs.
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