title: Comparison of fibrin sealant versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair.
abstract: OBJECTIVE
  To compare fibrin sealant (Tisseel) versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair.
  
  
  METHODS
  The charts of 114 patients (211 eyelids) who had undergone Müller muscle-conjunctiva resection were retrospectively reviewed. Suture versus Tisseel were used for wound closure. Preoperative and postoperative eyelid measurements, postoperative symmetry within 0.5 mm, and complications were compared.
  
  
  RESULTS
  Müller muscle-conjunctiva resection ptosis repair was performed on 211 eyelids of 114 patients. Seventeen cases were unilateral and 97 cases were bilateral. Method of wound closure included suture (45 eyelids of 31 patients) versus Tisseel (166 eyelids of 83 patients). For the suture group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.9. For the Tisseel group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.8. The 2 groups did not differ statistically in preoperative (p = 0.97) or postoperative MRD1 values (p = 0.53), the difference (p = 0.63), or postoperative symmetry within 0.5 mm (p = 0.39). In the suture group, complications included moderate to severe pain (10%), suture granuloma (6%), corneal abrasion (3%), loose suture (3%), and persistent keratopathy (3%). We found no evidence of keratopathy attributable to the Tisseel (p = 0.0001). This difference in the prevalence of complications was statistically significant (p = 0.0001). Four patients in the suture group (13%) underwent subsequent procedures including suture granuloma removal (2) and suture removal (1); 1 patient (3%) required levator resection. Three patients in the Tisseel group (4%) subsequently underwent levator resection.
  
  
  CONCLUSIONS
  Müller muscle-conjunctiva resection ptosis repair using fibrin sealant for wound closure offers comparable eyelid position results compared with suture. Use of Tisseel showed fewer postoperative complications and was associated with fewer subsequent surgical procedures.
authors.affiliation: Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA. mcheung26@yahoo.com
authors.forename: Marsha C
authors.initials: MC
authors.lastname: Kavanagh
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Ohr
authors.forename: Craig N
authors.initials: CN
authors.lastname: Czyz
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Cahill
authors.forename: Julian D
authors.initials: JD
authors.lastname: Perry
authors.forename: David E E
authors.initials: DE
authors.lastname: Holck
authors.forename: Jill A
authors.initials: JA
authors.lastname: Foster
mesh_terms: D001763:Blepharoptosis / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use*; D006099:Granuloma / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013537:Sutures / Q000009:adverse effects; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives