Fibrin Glue for Sutureless PreserFlo Surgery: A Case Series

TL;DR

This study shows that using fibrin glue in sutureless PreserFlo surgery significantly lowers eye pressure and reduces medication needs in advanced glaucoma patients.

Contribution

The novel use of fibrin glue for sutureless conjunctival closure and scleral band fixation in PreserFlo MicroShunt surgery is evaluated for the first time.

Findings

Mean intraocular pressure dropped from 34.9 mmHg to 11.3 mmHg at six months.

Glaucoma medications decreased from an average of 3.3 to 0.1.

No glue-related complications occurred despite some surgical issues like tube exposure and macrohyphema.

Abstract

Purpose

To evaluate the efficacy of sutureless PreserFlo MicroShunt insertion using fibrin glue for conjunctival closure and scleral band fixation in patients with advanced glaucoma in Cairns, Australia.

Methods

A retrospective case series evaluated seven patients undergoing urgent PreserFlo MicroShunt insertion at Cairns Hospital (March 2023 to November 2024). VeraSeal fibrin glue was used for conjunctival closure, with scleral band fixation in three cases. Pre- and post-operative intraocular pressure (IOP), visual acuity (VA), and ocular hypotensive medications were measured. Primary outcomes included intraocular pressure (IOP) and glaucoma medication reduction at six months and non-routine post-operative reviews within the first month. Secondary outcomes were complications and revision surgery needs. Success was defined as >20% IOP reduction at six months.

Results

Seven patients (mean age 74 years, range 54-87 years; three neovascular glaucoma, three primary open-angle glaucoma, one aphakic glaucoma) were included. Mean IOP decreased from 34.9±16.5 mmHg to 11.3±3.8 mmHg at six months. Medications reduced from a mean of 3.3 (range 3-5) to 0.1 (range 0-1). Non-routine visits averaged 3.7 (range 3-4). Complications included transient hypotony (n=1), tube exposure (n=1, managed with fibrin glue), macrohyphema (n=3), and pre-existing Snuff syndrome (n=2). No glue-related complications occurred. Scleral band fixation cases showed well-formed blebs without extrusion.

Conclusions

Sutureless PreserFlo MicroShunt with fibrin glue and scleral band fixation effectively reduces IOP and medication use with minimal complications and follow-up. Further studies are needed to validate this approach.

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