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The Use of Fibrin Glue in Conjunctival Limbal Autograft Transplantation

The Use of Fibrin Glue in Conjunctival Limbal Autograft Transplantation. Yonca Aydin Akova MD, Leyla Erkanli Asena MD Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey. The authors have no financial interest in the subject matter of this poster.

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The Use of Fibrin Glue in Conjunctival Limbal Autograft Transplantation

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  1. The Use of Fibrin Glue in Conjunctival Limbal Autograft Transplantation Yonca Aydin Akova MD, Leyla Erkanli Asena MD Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey The authors have no financial interest in the subject matter of this poster ASCRS Symposium on Cataract, IOL and Refractive Surgery 2011, March 25-29 San Diego

  2. Purpose • To report the results of conjunctival limbal autograft transplantation (CLAT) surgery using fibrin glue in 3 patients with limbal stem cell deficiency

  3. Patients and Methods Outcome variables • Pre- and postoperative best corrected visual acuities (BCVA) • Duration of the surgical procedure • Graft stability • Complications • 3 eyes of 3 patients with limbal stem cell deficiency (LSCD) • 2 patients with chemical (alkali) injury • 1 patient following long term treatment for acanthamoeba keratitis • CLAT surgery using fibrin glue • Only few fixation sutures on the conjunctival side for ensuring graft stability • No sutures on the corneal side • The mean duration of postoperative follow-up • 23,3 (18-30) weeks

  4. Results • Patient comfort was satisfactory • Decreased pain and inflammmation • No intra- or postoperative complications • The graft was stable in two patients • Minimal graft retraction in one patient due to vigorous eye-rubbing • The mean duration of the surgical procedure was 40,7 (34-48) minutes • Directly proportional to the time needed for superficial keratectomy • Visual acuity increased in all patients • Preoperative BCVA (Snellen) • Patient 1: 0.1 • Patient 2: 0,3 • Patient3: 0,4 Postoperative BCVA (Snellen) Patient 1: 0,8 Patient 2: 0,5 Patient 3: 0,7 Patient 2

  5. Patient 1 • Postoperative week 1 • Postoperative month 2

  6. Patient 3 • Preoperative • Postoperative Week 1 • Postoperative Day 1

  7. Limbal Stem Cell Deficiency Etiology Trauma • Chemical injury, thermal injury, recurrent surgery, long term contact lens wear Inflammation • Stevens-Johnson Syndrome, Ocular Cicatricial Pemphigoid, severe microbial keratitis Other • Aniridia, multiple endocrine neoplasia associated keratitis

  8. Limbal Stem Cell Deficiency Clinical Findings Therapy • Antiinflammatory agents • Topical and subconjunctival bevacizumab • Amniotic membrane transplantation • Penetrating keratoplasty combined with limbal stem cell transplantation • Unilateral cases- Conjunctival limbal autograft transplantation • Fibrin glue • Corneal surface irregularity • Punctate superficial flourescein staining- epithelial defects • Conjunctival epithelial cells migrating from the limbus to the central cornea “conjunctivalization” • Corneal neovascularisation • Chronic corneal inflammation, scarring and ulcer formation

  9. Sutureless Conjunctival Limbal Autograft Transplantation with Fibrin Glue Fibrin Glue Advantages: • Decreased duration of surgery • Better tissue apposition • Decreased risk for postoperative wound infections • Suture related infections↓ • Antimicrobial activity of aprotinine (?) • Increased patient comfort Fibrin Glue Disadvantages : • Allergic reactions due to aprotinine • Rare • Cost? • ~132 $ per ml (one patient) Panda A, Kumar S. et all. Indian J Ophthalmol 2009;57:371-179 Chen Wl, Lin CT. et. all. Cornea 2007;26:1228-1234

  10. Conclusion The use of fibrin glue in CLAT • Decreases the duration of the surgical procedure • Decreases the rate of suture related complications • Debris accumulation • Wound infection • Increased patient comfort Preoperative A rational alternative in the surgical treatment of LSCD Postoperative

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