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C. V. Duss, R. Wagner, S. Guo; Fibrin Glue Conjunctival Closure for Oblique Muscle Strabismus Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4872.
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To evaluate an alternative method for closure of the conjunctiva in oblique muscle strabismus surgery. Traditionally, after fornix based incisions, the conjunctiva is either closed with sutures, or left without closure. Sutures may cause significant post operative discomfort and can lead to granuloma formation requiring additional surgery. Leaving conjunctiva without closure carries additonal risk of bleeding or adhesion syndromes. In this study, we evaluate the effectiveness of TISSEEL VH fibrin glue for conjunctival closure in oblique muscle surgery.
Four patients who were undergoing inferior oblique muscle recession were selected. One of the patients was also having bilateral medial rectus recession. In the operating room, the conjunctiva of one eye was closed with one 6-0 plain gut suture. In the fellow eye, the conjunctiva was then closed using TISSEEL VH fibrin glue. The patients were followed at one week and three weeks post-operatively. Outcome measures included intraoperative time, post operative erythema, chemosis, apposition of conjunctiva, and patient discomfort and irritation.
All eyes maintained adequate closure of the conjunctiva post-operatively. There were no intra-operative or post-operative complications in either group. Eyes closed with fibrin glue were associated with significantly less post-operative inflammation and patient discomfort. While post-operative erythema and chemosis were variable, all eyes treated with fibrin glue had equal or less erythema than did eyes that underwent suture closure. All patients and parents were asked post-operatively which eyes had more discomfort; all four reported significantly less discomfort in the fibrin glue treated eye.
Early results in TISSEEL VH fibrin glue closure of the conjunctiva in strabismus surgery are promising for a safe and effective alternative to traditional suture closure or no closure. The greatest benefits of glue closure are decreased patient discomfort as compared to suture closure, a possible reduction of the risk of adhesion syndromes as compared to no conjunctival closure, improved cosmesis sooner in the post-operative period, and potentially decreased OR time and time under general anesthesia. We have experienced no adverse events in our experience using fibrin glue; however, larger series of patients are necessary for a complete safety profile. Future research will focus on a larger series which also compares no conjunctival closure to fibrin glue.
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