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Intracameral fibrin glue in spontaneous corneal perforation
Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea
J. Celis, D. Mesa
, E. Avendaño, F. González-Valle
Corresponding author
Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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Celis, D. Mesa, E. Avendaño, F. González-Valle" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Celis" ] 1 => array:4 [ "nombre" => "D." "apellidos" => "Mesa" "email" => array:1 [ 0 => "dimeva23@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Avendaño" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "González-Valle" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 996 "Ancho" => 1654 "Tamanyo" => 237490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Intra-surgery steps: (a) initial condition prior to intervention; (b) paracentesis with 15° blade; (c) introduction of viscoelastic four placing the chamber at the entry of the incision; (d) introduction of Tissucol<span class="elsevierStyleSup">®</span> in anterior chamber to fill in the perforation; (e) placing double amniotic membrane patch with Tissucol<span class="elsevierStyleSup">®</span>; and (f) post-surgery condition.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">One of the main causes of spontaneous corneal perforation is herpetic stromal keratitis. Therapeutic approaches include conjunctival flaps, scleral patches and the use of amniotic membrane associated or not with tissue adhesives. Management is more complex if centrally located. The last resort would involve therapeutic keratoplasty.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Fibrin adhesives are hemostatic agents that reproduce the last steps of the coagulation cascade. These adhesives are biocompatible, biodegradable and with low toxicity for corneal surfaces. The use of these adhesives in the anterior chamber for treating corneal perforation is presented.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case</span><p id="par0015" class="elsevierStylePara elsevierViewall">Male, 70, referred to the service due to corneal perforation in the context of herpetic ulcer with 2 weeks evolution in the LE. Upon exploration, the patient exhibited visual acuity of hand movements, signs of 360° limbar insufficiency and central ulcer with stromal thinning of approximately 2<span class="elsevierStyleHsp" style=""></span>mm with perforation. The perforation was under 1<span class="elsevierStyleHsp" style=""></span>mm. In addition, the patient exhibited positive seidel and athalamia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Systemic antibiotic treatment was prescribed (ciprofloxacin 200<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h intravenous), oral acyclovir (400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h), reinforced eyedrops (vancomycin 50<span class="elsevierStyleHsp" style=""></span>mg/ml and ceftazidime 50<span class="elsevierStyleHsp" style=""></span>mg/ml) and a therapeutic contact lens was placed (Lenflex II<span class="elsevierStyleSup">®</span>, Lentiflex Labs with 18.5<span class="elsevierStyleHsp" style=""></span>mm diameter). The surgical approach was made with blade 15<span class="elsevierStyleHsp" style=""></span>G and introduction of a small amount of viscoelastic (Viscoat<span class="elsevierStyleSup">®</span>, Alcon Labs) for partially reshaping the anterior chamber. Using a 27<span class="elsevierStyleHsp" style=""></span>G needle, the fibrin tissue adhesive was introduced (Tissucol<span class="elsevierStyleSup">®</span>, Baxter Labs) with both components simultaneously to fill the perforation. Two amniotic membrane patches were cut with the epithelium facing upwards, attached without requiring stitching (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the immediate post-surgery period, the amniotic membrane remained in position and the chamber was reshaped with the tissue adhesive covering the perforation on its endothelial side (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Four days after surgery and after withdrawing the occlusive bandages, the amniotic membrane dislocated but residues of Tissucol<span class="elsevierStyleSup">®</span> remained in the anterior chamber adhered to the perforation and the formed anterior chamber. A large diameter therapeutic contact lens was placed. At week 3, the tissue adhesive had dissolved completely but the perforation had sealed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Mirror microscopy counted 1235 cells with hexagonality of 58%.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Corneal perforation is a severe ocular complication that requires urgent treatment in order to avoid more associated ocular morbidity.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tissue adhesives are useful for immediate closure of small perforations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Adhesives can be classified as synthetic (derived from cyanoacrylate) and biological (fibrin adhesives). Cyanoacrylate is a nonbiodegradable adhesive that induces inflammation and neovascularization, whereas fibrin is a biodegradable biological adhesive that does not induce stromal inflammation or neovascularization and enables complete closure of perforations.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Tissucol<span class="elsevierStyleSup">®</span> is a fibrin adhesive with two components, one including fibrinogen and the other thrombine. When both come together they represent the final steps of the coagulation cascade, forming a stable fibrin coagulus that enables hemostasia in bleeding and the adhesion of tissue.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There are numerous papers on the use of tissue adhesives in corneal perforations applied on the surface but very few studies on the use of fibrin adhesives in anterior chamber.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The results of a study carried out with rabbits<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> demonstrated that intrachamber use of fibrin could produce temporary intraocular pressure increase as well as corneal pachymetry increase in the immediate post-surgery. However, no alterations were found in the corneal endothelium, trabecular mesh or iris.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Fibrin dissolves 1–2 weeks after surgery.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Intrachamber Tissucol<span class="elsevierStyleSup">®</span> in combination with the use of amniotic membrane can be useful for treating small corneal perforations. Perforation management is more simple when introducing the adhesive in the anterior chamber and producing an internal stopper. The excess adhesive protruding from the perforation can be utilized for attaching the amniotic membrane, which improves the mechanical attachment of the adhesive and facilitates perforation covering.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Comparatively, cyanoacrylate is more difficult to manage and leaves a rough surface that causes discomfort in the postop and frequently detaches at an early stage.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The authors wish to emphasize the satisfactory results of the said treatment as well as adequate endothelial tolerance to the fibrin adhesive without the complications described at the experimental level with the use of Tissucol<span class="elsevierStyleSup">®</span> in the anterior chamber.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflict of interests has been declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres352614" "titulo" => array:3 [ 0 => "Abstract" 1 => "Case report" 2 => "Discussion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec334077" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres352615" "titulo" => array:3 [ 0 => "Resumen" 1 => "Caso clínico" 2 => "Discusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec334078" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-10" "fechaAceptado" => "2012-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec334077" "palabras" => array:3 [ 0 => "Corneal perforation" 1 => "Tissue glue" 2 => "Amniotic membrane" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec334078" "palabras" => array:3 [ 0 => "Perforación corneal" 1 => "Pegamento biológico" 2 => "Membrana amniótica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 70-year-old male was referred to our department due to a herpetic corneal perforation in the left eye. The perforation was healed with intracameral fibrin tissue sealant (Tissucol<span class="elsevierStyleSup">®</span>), an amniotic membrane, and a large diameter soft contact lens. Postoperatively there were complete dissolution of the fibrin sealant and closure of the perforation without endothelial damage.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intracameral fibrin glue may be effective in the closure of corneal perforations.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Paciente varón de 70 años remitido a nuestro servicio por una perforación corneal en el ojo izquierdo (OI) de posible origen herpético. Se procedió a su reparación mediante la introducción de pegamento tisular de fibrina (Tissucol<span class="elsevierStyleSup">®</span>) en cámara anterior, colocación de parche de membrana amniótica y lente terapéutica de gran diámetro. En el postoperatorio presentó cierre de la perforación y resolución de la fibrina intracameral sin daño endotelial.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El pegamento tisular de fibrina puede ser utilizado en cámara anterior para tratar perforaciones corneales con excelentes resultados.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Celis J, Mesa D, Avendaño E, González-Valle F. Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea. Arch Soc Esp Oftalmol. 2014;89:124–126.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 930 "Tamanyo" => 81563 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Central perforation with complete ocular globe athalamia.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 996 "Ancho" => 1654 "Tamanyo" => 237490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Intra-surgery steps: (a) initial condition prior to intervention; (b) paracentesis with 15° blade; (c) introduction of viscoelastic four placing the chamber at the entry of the incision; (d) introduction of Tissucol<span class="elsevierStyleSup">®</span> in anterior chamber to fill in the perforation; (e) placing double amniotic membrane patch with Tissucol<span class="elsevierStyleSup">®</span>; and (f) post-surgery condition.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 703 "Ancho" => 930 "Tamanyo" => 78132 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Early post-surgery 24<span class="elsevierStyleHsp" style=""></span>h after the intervention: double amniotic membrane layer adhered with Tissucol<span class="elsevierStyleSup">®</span>.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 661 "Ancho" => 930 "Tamanyo" => 75068 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Slit section 3 weeks after the intervention with good anterior depth chamber and perforation closure.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. 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Tan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e31818ad9d0" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "451" "paginaFinal" => "455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19411966" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical experience with N-butyl cyanoacrylate tissue adhesive in corneal perforations secondary to herpetic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Moorthy" 1 => "V. Jhanji" 2 => "M. Constantinou" 3 => "J. Beltz" 4 => "E.O. Graue-Hernandez" 5 => "R.B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 2 | 4 |
| 2018 February | 30 | 0 | 30 |
| 2018 January | 31 | 1 | 32 |
| 2017 December | 32 | 2 | 34 |
| 2017 November | 60 | 0 | 60 |
| 2017 October | 31 | 3 | 34 |
| 2017 September | 63 | 2 | 65 |
| 2017 August | 95 | 3 | 98 |
| 2017 July | 101 | 10 | 111 |
| 2017 June | 137 | 4 | 141 |
| 2017 May | 162 | 1 | 163 |
| 2017 April | 72 | 3 | 75 |
| 2017 March | 184 | 34 | 218 |
| 2017 February | 92 | 1 | 93 |
| 2017 January | 47 | 0 | 47 |
| 2016 December | 70 | 7 | 77 |
| 2016 November | 71 | 2 | 73 |
| 2016 October | 64 | 6 | 70 |
| 2016 September | 72 | 6 | 78 |
| 2016 August | 34 | 1 | 35 |
| 2016 July | 26 | 1 | 27 |
| 2016 June | 22 | 2 | 24 |
| 2016 May | 30 | 24 | 54 |
| 2016 April | 35 | 6 | 41 |
| 2016 March | 28 | 4 | 32 |
| 2016 February | 26 | 5 | 31 |
| 2016 January | 38 | 9 | 47 |
| 2015 December | 25 | 6 | 31 |
| 2015 November | 33 | 4 | 37 |
| 2015 October | 26 | 7 | 33 |
| 2015 September | 27 | 3 | 30 |
| 2015 August | 43 | 8 | 51 |
| 2015 July | 56 | 6 | 62 |
| 2015 June | 26 | 5 | 31 |
| 2015 May | 35 | 2 | 37 |
| 2015 April | 32 | 3 | 35 |
| 2015 March | 35 | 2 | 37 |
| 2015 February | 23 | 2 | 25 |
| 2015 January | 16 | 6 | 22 |
| 2014 December | 27 | 7 | 34 |
| 2014 November | 26 | 4 | 30 |
| 2014 October | 27 | 4 | 31 |
| 2014 September | 45 | 16 | 61 |
| 2014 August | 5 | 1 | 6 |
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