Fibrin glue-assisted posterior IOL implantation is a beneficial technique for clinical indications such as dislocated nucleus, dislocated IOL, or subluxated cataract.
The sutureless procedure is performed easily and rapidly with currently available IOLs and instruments and may have a lower incidence of complications than implantation of sutured scleral-fixated IOLs, said Dr. Agarwal, professor of ophthalmology and director, Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.
Dr. Agarwal, who introduced the use of quick-acting surgical fibrin sealant in eyes with deficient or absent posterior capsule in 2007, has compared this technique with a sutured scleral-fixated IOL (SFIOL). Cadaver studies using graded pressure and known weights placed on both IOLs demonstrated that the glued IOL showed stability on par with the sutured SFIOL.
In the glued IOL technique, the surgeon creates two partial-thickness scleral flaps 180° apart, then performs a sclerotomy with a 22-gauge needle 1 mm from the limbus. Using 23- or 25-gauge forceps (MicroSurgical Technology), the surgeon can grasp and externalize the haptics, and tuck them into scleral tunnels made at the edge of the flap with 26-gauge needles.
The flaps are sealed into place with the fibrin glue, which is accomplished in about 20 seconds.
"Gluing adds further to stability and seals the flaps hermetically," Dr. Agarwal said.
Movement of the IOL parallel to the limbus is prevented with the glue application, while movement perpendicular to the limbus also is prevented because the entire haptic is in the tunnel created by a 26-gauge needle.
The surgical fibrin glue used by Dr. Agarwal (Tisseel, Baxter Healthcare Corp.) is derived from human blood plasma, and has hemostatic and adhesive properties.
Its use in IOL implantation is off-label, although fibrin glue often is used by ophthalmologists for treating pterygium, in keratoplasties, or for treating epithelial ingrowths after LASIK.
The lenses suitable for this procedure are three-piece foldable IOLs with slightly firm haptics or nonfoldable IOLs.