Use of Tisseel Fibrin Sealant to Repair Descemet Membrane Perforation During DALK

Use of Tisseel Fibrin Sealant to Repair Descemet Membrane Perforation During DALK

Ketcherside C.S., Berger G.R., Taravella M.University of Colorado

The authors have no financial interests

Background Tisseel is a commercially available two-component fibrin

sealant which acts as tissue glue with sealing, hemostatic and gluing properties.

The glue has two components (1) a freeze-dried powder composed of human fibrinogen,

fibrinonectin, plasminogen and Factor XIII reconstituted in a bovine aprotinin solution (2) a solution composed of human thrombin reconstituted in a calcium chloride solution.

When both of these solutions interact, through the action of thrombin, the fibrinopeptides are broken down to fibrin monomers. These monomers aggregate by cross-linking, leading to the formation of fibrin clot.

Tisseel is also available as a frozen, pre-filled syringe.

Srinivasan S, Dollin M, McAllum P et al. Fibrin glue versus sutures for attaching the conjunctival autograft in

pterygium surgery: a prospective observer masked clinical trial. British Journal of Ophthalmology 2009;93:215-218

Some Uses of Tisseel ILK Pterygium excision Multiple uses with amniotic membrane transplant Corneal perforation Vitrectomy Conjunctivochalasis PCIOL sutureless implantation Scleral melt Lamellar keratoplasty LASIK complications Glaucoma surgery Cataract wound closure

What we did…

Routine Deep Anterior Lamellar Keratoplasty with Big Bubble technique

Good trephination to start Attempted to dissect deep stroma and perforated

anterior chamber with 27 gauge needle Chamber remained deep with air fill Able to use Big Bubble dissection in alternate area

of the cornea

What we did…

Proceeded as usual while taking care to avoid area of perforation and dissect this area last

With dissection of tissue over perforation, chamber collapsed

Reformed chamber with air and used single drop of Tisseel to seal the Descemet’s perforation

We experienced no further complication

Perforation

Use of Alternate Site

Dissect this area last

One drop of Tisseel

Lamellar graft in place

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