The Efficacy of Fibrin Sealant in Sutureless Deep Sclerectomy - Preliminary Outcomes.

Abstract

Deep sclerectomy with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing non-allergenic, non-toxic and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively. To evaluate short- and medium-term postoperative results of deep sclerectomy (DS) with a fibrin sealant. This prospective, noncomparative, interventional case-series involves 12 eyes of 12 patients with uncontrolled open-angle glaucoma (OAG) who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon´s fascia and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure (IOP) and glaucoma therapy (GT) reduction, best-corrected visual acuity (BCVA) changes and number of complications registered peri- and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9 and 12 months after surgery. The mean IOP decreased from 24.0±9.1mmHg to 13.8±6.3mmHg at one year postoperatively (P<0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean GT decreased from 3.2±1.1 to 0.8±1.3 drugs 12 months after surgery (P<0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant BCVA changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in one eye, transient hypotony in 5 eyes and mild hyphema in 2 eyes. Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.