Our surgeons are using a relatively new biological glue in some surgery cases. We have found that Tisseel, a fibrin sealant, works well to secure pterygium grafts in place. This product can also effectively seal the edges of LASIK caps when epithelial cell ingrowth causes problems.

Fibrin sealants have been used extensively by surgeons in Europe, but Tisseel, a product developed by Baxter, was the first to receive FDA approval in the United States. It combines a highly concentrated solution of human fibrinogen with thrombin to produce a natural glue-like substance which replicates the blood clotting process to stop bleeding in surgical procedures. It also quickly seals tissue together—something like Super Glue—and in some circumstances, can replace the use of sutures.

Tisseel is a complex, natural agent that achieves rapid homoestatsis and tissue sealing in a variety of surgical applications. It has been shown to be safe and effective in:

• cardiovascular surgery—reducing the time to stop bleeding
• spleen repair—reducing the number of splenectomies
• colostomy closure—reducing complications in temporary colostomies when used directly over the suture lines

Although Tisseel was not created for eye surgery, our surgeons were some of the first American ophthalmologists to use this unique product in pterygium and LASIK surgery cases.

Tisseel can be used in pterygium surgery to secure the conjunctival graft in position and hold it in place until the tissue can heal. This takes the place of 8 to 10 vicryl sutures that are fairly stiff and can cause considerable ocular irritation for a week or two until they dissolve. Fibrin sealant nicely secures the graft, dissolves in 8 to 10 days, and eliminates suture discomfort. In our experience, pterygium surgery patients have an easier post-operative course with fibrin sealant than with traditional sutures.

Another application of Tisseel is in LASIK surgery. Occasionally patients develop epithelial cell ingrowth under the cap. Usually, after the cap is lifted once and the cells are removed, ingrowth is stopped. However, in some cases, recurrent cell ingrowth causes ongoing problems. When this occurs, our surgeons may apply Tisseel to seal the cap edge after cell removal. Although vision may be reduced for 3 to 10 days until the sealant is absorbed, it has been effective in preventing recurrent epithelial cell ingrowth.

Tisseel fibrin sealant is made up of key plasma derivatives from the last stages of the natural coagulation pathway—where soluble fibrinogen is converted into a solid fibrin matrix. The product comes with a small kit for mixing, heating and combining the various elements. An applicator, comprised of 2 identical disposable syringes and joined by a common plunger, assures delivery of equal volumes of each component. Once the sealant is applied, it sets up quickly.

Benefits of fibrin sealants include:

• tissue compatibility
• lack of toxicity
• natural bioabsorbtion as it dissolves
• superior adhesiveness
• elasticity

These advantages contribute to the versatility of fibrin sealants as a valuable adjunct to surgical procedures.