Tissue adhesive effective in total anterior lamellar keratoplasty

Lisbon, Portugal - The use of fibrin glue seems to be effective and safe in total anterior lamellar keratoplasty (TALK), a procedure that completely exposes Descemet’s membrane within the area of host corneal trephination combined with transplantation of donor cornea without Descemet’s membrane and endothelium.  Thomas John, MD, explained the procedure Sunday at the European Society of Cataract and Refractive Surgeons meeting.

Ten patients (6 women, 4 men; average age, 48 years) underwent this procedure. Seven patients were diagnosed with keratoconus and three patients with corneal scarring.  The symptoms included blurred vision and glare and scarring in the visual axis.

Because of the severity of the cases, the automated lamellar technique was not possible and manual TALK was performed in all cases, said Dr. John, of Loyola University at Chicago, Maywood, IL, United States.

During the procedure the fibrin glue, which comprises thrombin and fibrinogen, is applied to the entire donor/stromal interface including the visual axis.

Dr. John reported that use of the glue resulted in an even smooth adherence of the host Descemet’s membrane to the donor stroma in all cases. No folds in Descemet’s membrane were present. Postoperatively, the cornea healed uniformly without inflammation or interface scarring of the cornea.

“The glue, which is both bioabsorbable and biocompatible, is safe for use in the visual axis. The glue is a new and effective technique in TALK and its use results in uniform postoperative healing,” Dr. John explained.

An added benefit of this procedure is that it is an extracapsular procedure as compared with air injection, which is an intraocular procedure, he said.