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Fibrin glue similarly effective to sutures for glaucoma drainage device surgery

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Fibrin glue appears to be an effective substitute for sutures in glaucoma drainage device implantation, according to a study.

Researchers reviewed their results using Tisseel fibrin glue (Baxter AG) for implanting a Baerveldt glaucoma drainage device (Advanced Medical Optics) and Tutoplast (Innovative Ophthalmic Products) in 14 consecutive patients. Malik Y. Kahook, MD, and Robert J. Noecker, MD, of the University of Pittsburgh School of Medicine, compared the results to a control group of 28 patients who underwent surgery using traditional vicryl sutures.

A similar surgical technique was used for both groups, the authors noted.

The researchers found that the fibrin glue significantly reduced surgical time compared to suturing. Operative time averaged 15 minutes for the Tisseel-treated group and 25.93 minutes for the suture group (P < .0001), according to the study.

The increased efficiency offsets the glue's higher cost, having an estimated potential savings of $389 per case. Additionally, the fibrin glue caused significantly less postoperative conjunctival inflammation and hyperemia (P = .0019). Eyes treated with the glue also "consistently ... healed in a more even fashion," the authors said.

Use of the fibrin glue did not increase rates of complications, such as tube displacement or patch graft migration, they noted.

At 3 months' follow-up, there was no significant difference in IOP between the two groups, and both groups had similar rates of postop glaucoma medication use, according to the study.

The authors acknowledge that using the glue has some drawbacks. The glue requires special equipment for heating, and there is a learning curve associated with efficient preparation. The glue can also be difficult to precisely apply and, once applied, grafts must be applied quickly, they said.

"Longer-term studies, in a prospective randomized fashion, are planned to tease out any differences that might exist between [fibrin glue and sutures]," the authors said.

The study is published in the August issue of the British Journal of Ophthalmology.