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    Ocular sealant proves effective for routine, unexpected cases

    Agent migrates to areas that do not have epithelium attached; eye must be dry for adherence

     

    Using the sealant has cut back suturing time by 5 minutes. The sealant naturally sloughs off in a day or two, but if a bandage contact lens (BCL) is used, it will last for a week or more.

    One caveat is that the eye must be dry for the sealant to adhere. In many cases, aqueous is not actively flowing from the eye so the sealant can be applied without worry. In other cases, it may be necessary to drop IOP a bit or inject a small amount of viscoelastic into the eye to stop the flow of aqueous.

    Case series

    To evaluate the efficiency of the sealant as an adjunct to suture closure of the conjunctiva in glaucoma filtering surgery, 32 consecutive cases were compared in which the sealant was used to 30 prior consecutive cases in which sutures were used alone. All cases underwent a fornix-based approach.

    Best ophthalmic hospitals for 2015

    At the end of each case, two wing-sutures were placed at either end of the conjunctival flap. Care was taken to dry the intended area thoroughly with a Weck cell sponge. This removed any residual moisture that may have interfered with proper sealing, and also roughened up the epithelial layer overlying the conjunctival edge and cornea to facilitate proper adherence of the sealant. The two components of the sealant are mixed for about 5 seconds, and then the sealant is applied to the desired area within 10 seconds.

    Upon evaluation, there were no cases of early postoperative wound leak in the sealant group and two cases of leak in the group with sutures alone. The leaks were stopped with conservative measures with BCL and resolved by the first week postoperatively.

    Next: Concluding thoughts

    Robert J. Noecker, MD
    Dr. Noecker, vice chair, University of Pittsburgh Medical Center Eye Center, and director, Glaucoma Service and associate professor of ...

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