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J. K. Laursen, D. Caldwell; The Use of Fibrin Tissue Sealant to Promote Graft Adherence in the DSEK Procedure Using a Rabbit Model. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2222.
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© ARVO (1962-2015); The Authors (2016-present)
Graft dislocation remains the most frequent complication of Descemet Stripping Endothelial Keratoplasty (DSEK). The increased demand for these surgeries gives rise to the need to discover strategies to promote graft adherence at the time of the initial operation. The purpose of this pilot study in a rabbit animal model is to develop a novel surgical technique using fibrin tissue sealant at the graft-recipient interface to decrease the rate of primary dislocation following a DSEK procedure.
This is a pilot study on one eye each of 3 rabbits conducted in compliance with the Tulane IACUC and ARVO standards. Given the absence of Bowman’s membrane in rabbits, the donor rabbit epithelium was removed using absolute alcohol, then a standard DSEK procedure was performed. With the air bubble in place, a 30-gauge needle was used to inject a small amount of fibrin sealant into the graft-recipient interface through recipient cornea at 4 cardinal positions. These injections were placed 1 mm centrally of the graft edge but avoiding the optical center. Post-operative care included antibiotic with steroid ointment QID and daily examination for graft adherence until time of enucleation. Test eyes were enucleated, preserved, and examined histologically using H&E stain.
All rabbits had complete corneal clearing by day 7 and remained clear without AC reaction. On histological examination, there was no corneal edema, inflammation or interface fibrosis. There was 100% graft adherence and no histological evidence of retina toxicity.
Success rate of this innovative surgical technique was 100%. Using fibrin tissue sealant appears to be a safe and effective adjunct to the DSEK procedure. Additional experimental and control procedures are currently underway.
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