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M.J. Gallardo, D. Johnson, F. Trujillo, T. Starck; "Sutureless" Pterygium Surgery, an Alternative Method of Fibrin Sealant Application . Invest. Ophthalmol. Vis. Sci. 2005;46(13):954.
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Purpose: Fibrin glue, the product of mixing fibrin sealant and thrombin, has been shown to be effective for adhering conjunctival grafts in pterygium surgery. The use of the fibrin sealant alone, without using the thrombin simplifies the technique of "sutureless" pterygium surgery. The purpose of this review is to determine the conjunctival autograft (CAG) stability following pterygium excision that were secured solely with fibrin sealant. Methods: Seventeen patients with clinically significant pterygium underwent pterygium excision and harvesting of CAGs. The CAGs were placed onto the scleral bed maintaining limbal orientation. The fibrin sealant component of the tissue adhesive [Tisseel VH Fibrin Sealant (Baxter Healthcare Corporation, Glendale, CA)], was infused beneath the CAG and adjacent conjunctival margins without thrombin. All grafts adhered within 60 seconds. At the end of the procedure, patients were given subconjunctival injections of cefazolin and dexamethasone, and the eyes patched with neomycin–polymixin–dexamethasone combination ointment. Post–operatively, patients were treated with topical antibiotics until fully epithelialized and a tapering dose of prednisolone acetate for 3 months. Results:Between March 2004 and November 2004, 28 eyes of 28 patients underwent pterygium surgery with fibrin sealant application. No sutures were used in 17 eyes of 17 patients. Of these, 16 involved primary pterygia and 1 a double pterygium. Mean limbal dimension of the pterygia was 5.9 mm (range 4.5–8.0 mm). Mean corneal extension was 3.84 mm (range 1.0–5.4mm). Mean autograft size was 22.27 mm2 (range 20–32.5mm2). Mean follow up was 11.25 weeks (range 5–19 weeks). In these 17 cases, there were no episodes of CAG dehiscence, retraction, infection, allergic reaction, or pterygium recurrence. Conclusions: Tisseel VH Fibrin Sealant is a tissue adhesive composed of two components: fibrin sealant and thrombin. Both are either combined with a dual injector syringe upon application, or one component is applied to the scleral bed and the second to the conjunctival graft. Upon mixing, the resultant solution provides immediate adhesion of the graft onto the scleral bed that resists subsequent manipulation. Use of the fibrin sealant alone simplifies application since the solution is less viscous and allows several seconds for graft manipulation. In our series, we had no cases of graft loss or dehiscence suggesting that the fibrin sealant component alone provides sufficient adhesive strength for autograft surgery. Given our limited follow–up, no conclusions can yet be made regarding recurrence rates.
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