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C. Azzolini, E. Balì, E. Alessandrini, C.T. Paties, S. Ciaccia, M. Prati, C. Tanzi, R. Brancato; Practical Aspects of Human Fibrin Glue in Vitreoretinal Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3032.
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Purpose: Fibrin glues are studied in ophthalmology since 25 years, and in vitreoretinal surgery since 10 years. There is still no current application for the glue in vitreoretinal surgery. The aim of our study is to evaluate practical aspects in the use of fibrin glue in modern vitreoretinal surgery. Methods: Two ports pars plana vitrectomy (PPV) was performed in 4 pigs’ eyes enucleated within 8 hours. After the removal of all vitreous a retina hole was performed in the peripheral retina. In three eyes human fibrin glue was applied on the hole, and retina was then stabilized with perflourocarbon liquid (PFCL). In one eye retina was stabilized with PFCL and then fibrin glue was applied on the hole. After 5 minutes PFCL was removed in all eyes. Serial 3-µm sections were cut at intervals of 50 µm and stained with hematoxylin and eosin. Results: The injection of fibrin glue before the PFCL injection was suitable; in these eyes the hole was closed after PFCL removal. The injection of fibrin glue after PFCL injection was unsuitable because of fibrin glue uncontrollable diffusion and consequent sudden formation of a non usefull knot; in this eye the hole remained open. In two eyes there was leakage of the fibrin glue due to gravity and excessive fibrin glue had to be removed with the vitrectome. Histology showed the presence of fibrin glue under and around the hole margins in all eyes with a closed hole, in one eye no fibrin glue was found. Histology also showed that the fibrin glue can adhere to RPE as well as retina. Conclusion: Our result, even if in a very limited experience, showed that fibrin glue may close the hole if correctly applied. Main difficulties are unwanted diffusion of the fibrin glue due to gravity, the sudden polymerisation of the human fibrin glue and the lack of non dedicated surgical instruments. Much more studies and experimentation are necessary to reach the goal of usefull application of fibrin glue in vitreoretinal surgery.
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