Fibrin glue evaluation like an adjuvant in vitreo-retinal surgery.

Sir, We designed a study to evaluate the biocompatibility of fibrin glue (Beriplast®) in the vitreoretinal surgery by testing the same in an animal model. We have evaluated the existence of toxicity to the retina using clinical observation, histological analysis, and functional evaluation (electroretinogram). Tissue adhesives have a long history of use in ophthalmology and have been used as a structural filler or support instead of donor tissue, as a tissue fixative, for closing and apposing wound edges to minimize operating time and to reduce inflammation, as a barrier to facilitate epithelial healing, prevent collagen breakdown, and reducing vascularization.[1–4] Eight New Zealand albino rabbits were included for this study. A 20 gauge vitrectomy was done in each left eye and after a fluid-air exchange, a supero-temporal retinotomy (one optic disk diameter) was done. Furthermore, in the retinotomy, we placed 0.1 ml of the fibrin glue and the sclerotomies were closed conventionally. The right eye served as the contralateral control eye. Clinical examination of the eye and electroretinography (ERG) recordings were made before, the day after, and 1, 2, and 6 months after the procedure. Two of the 8 rabbits were killed in the respective evaluation period. They were killed with an overdose of pentobarbital for enucleation and histologic analysis. Slit lamp biomicroscopy, indirect funduscopy, and ERG evidenced no significant differences between control and fibrin glue exposed eyes in this rabbit model. Retina appeared unaltered, and retinotomies were attached in all eyes. Histologic examination revealed no retinal abnormality in the eyes exposed to the intravitreal fibrin glue when compared with the fellow control eye [Fig. 1]. Figure 1 (a) Photomicrographs of the hematoxylin-eosin-stained histologic retinal section of the fibrin glue treated left eye and (b) contralateral control eye No observable differences in thickness and cellular density were noted among the various retinal layers ... Our study suggests that fibrin glue used intravitrealy and in the retina for vitreoretinal surgery may be safe in the rabbit eye. Therefore, if proven to be safe and efficacious by further studies and also in human eyes, intraocular fibrin glue might be considered and used as the unique treatment or adjuvant for vitreoretinal surgeries such as accidental retinotomies and slidings of the retina in cases of rhegmatogenous retinal detachments. We believe that in near future, this could be used as a substitute of endophotocoagulation in certain cases. This study is an original idea, in our knowledge, no manuscripts have been published using fibrin glue in retinotomies.