Fibrin Glue for Pterygium Surgery Sathish Srinivasan FRCSEd, FRCOphth Consultant Ophthalmologist Ayr...
-
Upload
sydney-warren -
Category
Documents
-
view
220 -
download
1
Transcript of Fibrin Glue for Pterygium Surgery Sathish Srinivasan FRCSEd, FRCOphth Consultant Ophthalmologist Ayr...
Fibrin Glue for Pterygium Surgery
Sathish Srinivasan FRCSEd, FRCOphthConsultant OphthalmologistAyr Hospital, AyrScotland, UK
• A two-component fibrin sealant.
• Contains two of the protein that makes the blood clot.
• Fibrinogen and thrombin
• SEALANT PROTEIN: solution composed of Human fibrinogen, plasminogen, fibronectin and Factor XIII reconstituted in a Bovine aprotinin solution
• SEALANT SETTING: solution composed of Human thrombin reconstituted in a calcium chloride solution
What can you do with Tisseel?
• Control intra-operative bleeding
• Prevent post-operative haemorrhage
• Repair leaks including CSF
• Prevent post-op leakage including CSF
• To promote tissue adhesion
• To support a suture line
Fibrin Glue
• Complement good surgical haemostatic techniques, such as• Ligatures or sutures• Clips or staples• Electrocautery
• Provide a water or fluid-tight seal
CAN….
•Stop arterial bleeding
•Stop severe venous bleeding
CANNOT….
Clinical experience with Tisseel
• No documented transmission of:– HIV, Hepatitis B, Hepatitis C
• Over 33 years of use in many countries
• Available in 50 countries worldwide
• More than 17 million applications to date
• 3500+ publications in most surgical disciplines
Data on file, Baxter Healthcare
Tisseel Kit has 4 components
• 1 vial: Sealer protein lyophilized
concentrate.
• 1 vial: Lyophilized human thrombin.
• 1 vial: Aprotinin solution.
• 1 vial: Calcium chloride solution.
What's in it
• When reconstituted 1 ml of each solution contains:
• Human Fibrinogen: 72-110 mg in 96-125 mg protein, aprotinin (bovine) 3000 KIU/ml. Inactive ingredients include human albumin, L-Histidine, niacinamide, polysorbate 80 and sodium citrate.
• Human thrombin 5 or 500 IU, in 45-55
mg protein, calcium chloride 40
micromoles/ litre. Inactive ingredients
include human albumin and sodium
chloride.
• Human plasma pools are tested for presence
of genome sequences of HIV, HBV and HCV
• Tisseel is vapor-heated to inactivate viruses
• No evidence of disease transmission yet
• What about prions in Bovine aprotinin
Pharmacokinetics
• Tisseel is intended for epilesional use only.
• Intravascular pharmacokinetic studies have not been performed in humans.
• Fibrin sealants are metabolized in the same way as endogenous fibrin – fibrinolysis and phagocytosis.
Contraindications
• Not for intravascular use. Carries a high risk of thromboembolic complications.
• Remember it has a bovine protein (aprotinin) : risk of anaphylactic reaction.
• Risk is slightly higher in cases of previous exposure.
Fibrin Glue versus Sutures for attaching the Fibrin Glue versus Sutures for attaching the Conjunctival Autograft in Pterygium Conjunctival Autograft in Pterygium Surgery: A Prospective Observer Masked Surgery: A Prospective Observer Masked Clinical Trial Clinical Trial
Sathish Srinivasan FRCSEd, FRCOphthMichael Dollin MDPenny McAllum FRANZCOYoav Berger MDDavid S. Rootman MD, FRCSCAllan R. Slomovic MD, FRCSC
Table 1. Scoring parameters for each of the three Table 1. Scoring parameters for each of the three outcome variables outcome variables
Outcome Variables Scoring Parameters
Subconjunctival Hemorrhage
Grade 0: NoneGrade 1: ≤ 25% of the size of the graftGrade 2: ≤ 50% of the size of the graftGrade 3: ≤ 75% of the size of the graftGrade 4: Hemorrhage involving the entire graft (no subconjunctival
vessels visible)
Inflammation Grade 0: No dilated corkscrew vessel in the graftGrade 1: 1 bright red, dilated corkscrew vessel crossing the graft-bed marginGrade 2: 2 bright red, dilated corkscrew vessels crossing the graft-bed marginGrade 3: 3 bright red, dilated corkscrew vessels crossing the graft-bed marginGrade 4: ≥ 3 bright red, dilated corkscrew vessels crossing the graft-bed
margin
Graft Stability Grade 0: All 4 sides of the graft margin are well apposedGrade 1: Gaping/displacement of 1 side of the graft-bed junctionGrade 2: Gaping/displacement of 2 sides of the graft-bed junctionGrade 3: Gaping/displacement of 3 sides of the graft-bed junctionGrade 4: Graft completely displaced from the bed