The use of fibrin glue during aqueous shunt surgery

To examine the safety and economic effect of using fibrin glue to reduce suturing of a donor patch graft and in conjunctival closure during aqueous shunt implantation.

Retrospective interventional case series of 150 patients from a single institution including historical controls from before the introduction of the change in technique. The surgery was performed by multiple glaucoma surgeons.

One hundred and fifty eyes of 150 patients were identified. The mean age was 54.3 ± 21.1 years. Previous surgery included: cataract extraction (34.7%), trabeculectomy (36%) and retinal surgery (15.3%). All operations were carried out by either a consultant (57%) or fellow (43%). A Baerveldt Glaucoma Implant (Advanced Medical Optics, Santa Ana, California, USA) was used in 149 eyes. Conventional surgery (CS) was performed for 91 eyes and fibrin glue (FG) was used for 59 eyes. Compared with conventional surgery (CS) in which the donor patch graft and conjunctiva were sutured, use of fibrin glue (FG) reduced the overall mean operating time by 11.2 min ± 6.4 min (P = 0.031), though much less for consultants (8.5 min ± 6.2 min) (P = 0.16) than fellows (32.9 min ± 7.2 min) (P < 0.0001). There were four cases of conjunctival dehiscence-three in the FG group and one in the CS group (P = 0.30). Only one patient required re-suturing in the FG group.

The use of fibrin glue is safe and effective during aqueous shunt implantation. We have shown that the mean operating time can be reduced significantly with the use of fibrin glue which has significant implications for resource utilisation.