Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve

Abstract

Aim:To report our experience with the fibrin sealant as a suture substitute for securing the human scleral patch graft during implantation of Ahmed glaucoma valve (AGV).Materials and Methods:A retrospective, non-comparative study of 12 eyes of 12 patients who underwent an AGV implantation with fibrin sealant for part of the procedure during June 2009 to September 2010.Results:The mean patient age was 21.5 ± 20.6 years. Male: Female ratio was 2 : 1. Seven (58.3%) patients were monocular. The indications for AGV were varied. The mean number of intra-ocular surgeries prior to an implantation of AGV was 1.8. The mean follow-up duration was 24.5 ± 17.9 weeks. There was a statistically significant reduction in the mean IOP and in the mean number of anti-glaucoma medications at the final visit compared to the pre-operative values (P < 0.01, paired t test). Conjunctival retraction was seen in 1 (8.3%) case. The scleral patch graft was retracted posteriorly in another (8.3%) case. There was no case of AGV tube exposure, tube-cornea touch, or conjunctival erosion. Vision threatening complication viz. late post-operative rhegmatogenous retinal detachment, unlikely to be related to the use of the fibrin sealant, occurred in 2 (16.6%) eyes.Conclusion:The fibrin sealant offers the advantages of safety and convenience to the placement of a scleral patch graft during an AGV implantation.

Fibrin sealant-assisted revision of the exposed Ahmed tube

“… 7 On the other hand, fibrin sealant has been shown to be safe and effective suture substitute for conjunctival and scleral wound closure in glaucoma surgery 8 and for placement of a human donor scleral patch graft covering the sub-conjunctival portion of AGV tube. 9 10 In addition to saving suturing time, the fibrin sealant did allow sticking of the conjunctival graft to the edges of the conjunctiva on either side as well as to the underlying episcleral surface beyond the extent of the revision scleral patch graft in our case. Since our patient was relatively young and had a thick tenon's capsule, the adhesion was expected to be strong.…”

Tisseel Fibrin Glue vs Sutures for Conjunctival Closure in Glaucoma Drainage Implant Surgery

“…In glaucoma surgery fibrin glue has been studied extensively. Choudari et al, have described its use in securing a corneal patch graft over the tube in Ahmed glaucoma valve surgery [6]. Freeman et al, compared fibrin glue to sutures in pediatric GDI surgeries for securing the tube to the sclera, the pericardial patch graft over the tube, and closing the conjunctiva and found no differences in complication rates or post-operative IOPs [7].…”

Case Series of Brittle Cornea Syndrome

“…An option could be posterior plate location and a pars plana location of the tube at the time of lensectomy and vitrectomy. Also, the use of fibrin glue to secure the plate to the sclera as a substitute for the sutures has been reported [21][22][23]. Another approach, if topical pharmacotherapy is not successful, is cyclophotocoagulation with adjusted energy parameters [24].…”