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Jesus Alberto Martinez, Jenny Ha, Sandra Lora Cremers; Outcomes of multiple-dose fibrin glue during in-office pterygiectomy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):166.
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We performed a retrospective observational study to evaluate the safety and cost-benefits of off-label multiple-dose fibrin glue use in pterygium surgery.
The charts of eyes of consecutive patients who had received suture-less primary pterygiectomy from 05/2014 to 04/2016 with fibrin glue (TISSEEL, Baxter Inc., Westlake Village, CA) in an office-based surgery suite were reviewed. Two ml human sealer protein concentrate were reconstituted with synthetic fibrinolysis inhibitor solution and 2 ml calcium chloride solution were combined with human thrombin. For each surgical case, wearing sterile gloves, bottle tops were wiped with a new alcohol pad and 0.1-0.15 ml of each fibrinogen and thrombin solution were withdrawn with sterile 21G and 27G needles, respectively. The solutions remained in the sterile syringes until needed intraoperatively. A bandage contact lens was placed for 2 weeks after surgery. Pre and postoperative complications including graft dehiscence and displacement, recurrence, dellen, infections, and corneal ulcers, were collected. The price of glue for single use was compared to that of multiple use in pterygium surgery (one 4ml package for 10-12 pterygiectomies).
453 eyes of 385 patients with mean age 46.7±11.7 years (min-max 19-82) were included. There were 411 nasal, 7 temporal, and 35 nasal and temporal pterygia. No corneal ulcers were observed. There were 2 patients with mild graft displacement at 1 day post op but did not require additional glue or sutures. There were 2 (0.4%) dellen and 3 recurrences (0.6%). Each 4ml package of glue components was sufficient for 10-12 pterygiectomies resulting in a waste of 230 USD worth of TISSEEL tissue sealant.
The multiple-dose use of fibrin glue, when prepared in a sterile manner, is safe and results in reduction of medical waste and its associated costs. With the indicated single use, 95% of the unused glue is discarded.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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