A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Michael B. Yang, MD1; Michele Melia, ScM2; Scott R. Lambert, MD3; Michael F. Chiang, MD4; Jennifer L. Simpson, MD5; Angela N. Buffenn, MD, MPH6
Ophthalmology, September 2013, Vol 120, 1935-1941 © 2013 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To evaluate the severity of postoperative inflammation, degree of patient discomfort, adequacy of wound closure, and length of operating time when using fibrin glue compared with sutures to close limbal conjunctival incisions after strabismus surgery.
Methods: Literature searches of the PubMed and Cochrane Library databases were last conducted on January 24, 2013, and resulted in 24 citations, including 2 not in the English language. All citations were reviewed in full text. Five studies compared fibrin glue (68 eyes) with sutures (74 eyes) for closure of limbal conjunctival incisions in patients undergoing strabismus surgery and were included in this assessment; no studies were found that evaluated fornix incisions. A quality rating was assigned to each study using criteria specifically developed for this assessment.
Results: No level I studies were found, and 5 level II studies were identified. There was significantly less postoperative inflammation and patient discomfort for 1 to 3 weeks after strabismus surgery for eyes treated with fibrin glue compared with sutures. In 3 studies that evaluated wound apposition, 2 of 50 eyes (4%) with conjunctival incisions that were initially closed using fibrin glue subsequently developed a wound gap that required suture repair. In the 2 studies that compared surgical time, fibrin glue required 1 to 5 minutes less time than suturing in 1 study and 55% less time (3.8 vs. 8.4 minutes) in a second study. These 5 studies did not evaluate the cost-effectiveness or risk of viral transmission from fibrin glue.
Conclusions: Studies in the literature suggest that the off-label use of fibrin glue to close limbal conjunctival incisions in strabismus surgery resulted in less postoperative inflammation and required shorter operating time compared with sutures, but it increased the percentage of wounds requiring subsequent repair with sutures.
1Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, College of Medicine, Cincinnati, Ohio
2Jaeb Center for Health Research, Tampa, Florida
3R. Howard Dobbs Professor of Ophthalmology, Professor of Pediatrics, Department of Ophthalmology, Emory University, Atlanta, Georgia
4Knowles Professor of Ophthalmology & Medical Informatics and Clinical Epidemiology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
5Clinical Professor, Gavin Herbert Eye Institute, University of California, Irvine, California
6The Vision Center, Children's Hospital Los Angeles; Orbit and Eye Movement Institute, Strabismus and Pediatric Ophthalmology; Fellowship Program, Pediatric Ophthalmology and Strabismus; University of Southern California Keck School of Medicine, Los Angeles, California