Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion: a pilot study.
OBJECTIVE
To determine whether a fibrin adhesive can facilitate the performance of sutureless lamellar keratoplasty and attachment of amnion to bare sclera.


METHODS
Prospective, noncomparative case series.


METHODS
Six patients, 5 of whom underwent lamellar keratoplasty and 1 who received an amniotic patch of the sclera and cornea. Institutional review board approval was not required for these therapeutic treatments.


METHODS
In 5 patients, the epithelium was removed from the corneal surface, a free cap, 200- micro m thick, was cut with a microkeratome, and a human fibrin tissue adhesive (Tisseel VH Fibrin Sealant; Baxter Healthcare Corporation, Glendale, CA) was applied to the cut surface of the corneal stroma. A 200- micro m thick, microkeratome-cut lamellar graft was placed in the stromal bed without sutures, and a bandage soft contact lens was applied. The lens was left in place for 1 week and then removed. In 1 patient, the adhesive was applied to bare sclera for attachment of amniotic membrane after removal of a conjunctival melanosis. All patients were followed up for 3 months after surgery.


METHODS
Tissue adhesion, corneal clarity, and visual acuity.


RESULTS
All 5 lamellar grafts healed and remained clear, although final visual acuity varied with visual potential and astigmatism. The amniotic membrane graft also adhered well to the bare sclera.


CONCLUSIONS
The fibrin adhesive provided satisfactory attachment without sutures for lamellar keratoplasty and amniotic patching. It should be effective for sealing of clear cornea incisions, LASIK flaps, and conjunctival and skin grafts. An adhesive that has been designed specifically for ophthalmic applications and is more convenient to use would be desirable.
Department of Ophthalmology, LSU Eye Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA. hkaufm@lsuhsc.edu
Herbert E
HE
Kaufman
Michael S
MS
Insler
Hosan A
HA
Ibrahim-Elzembely
Stephen C
SC
Kaufman
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D003315:Cornea / Q000502:physiology; D016039:Corneal Transplantation / Q000502:physiology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D000267:Tissue Adhesions; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives