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. 2016 Jun 1:3:15.
doi: 10.1186/s40662-016-0046-6. eCollection 2016.

Effect of fibrin glue on corneal lamellar healing and how it correlates to biomechanical properties: biomechanical wavefront analysis and confocal study

Almamoun Abdelkader  1
Affiliations

Effect of fibrin glue on corneal lamellar healing and how it correlates to biomechanical properties: biomechanical wavefront analysis and confocal study

Almamoun Abdelkader. Eye Vis (Lond). .

Abstract

Background: To evaluate, using a rabbit model, the influence of the wound healing process at the flap edge on corneal biomechanics after sutured, glued, and non-augmented microkeratome flaps.

Methods: Unilateral 160 μm thick laser in situ keratomileusis (LASIK) flaps using a mechanical microkeratome were performed on the corneas of the left eyes of 36 rabbits. Animals were then divided into 3 groups of 12 rabbits each: A: the flaps were glued with human fibrin tissue adhesive (Tisseel); B: the flaps were sutured; and C: the flaps were allowed to heal without the use of sutures or glue (non-augmented). The contralateral eyes served as controls. Reichert ocular response analyzer (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and cornea-compensated IOP (IOPcc) at 6 weeks and 3 months postoperatively. In vivo confocal microscopy (IVCM) was also used to study the corneal wound healing process in all groups.

Results: Both mean CH and mean CRF were significantly higher in sutured and glued groups compared with the non-augmented group at 6 weeks and 3 months postoperatively (P < 0.0001). No statistically significant difference in corneal biomechanics was found between controls and groups A and B at any time points. Activated keratocytes were detected at the wound edge and peripheral flap interface in sutured and glued groups.

Conclusion: The healing process at the wound edge is critical for optimal corneal integrity. Fibrin glue may serve as a safe and effective substitute to sutures in enhancing the corneal flap edge healing response and in increasing its mechanical strength.

Keywords: Confocal microscopy; Corneal hysteresis; Corneal resistance factor; Ocular Response Analyzer (ORA); Wound healing.

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Figures

Fig. 1
Fig. 1
Mean postoperative corneal hysteresis (CH) values for all groups. P < 0.0001 for sutured and glued groups vs. non-augmented groups
Fig. 2
Fig. 2
Mean postoperative corneal resistance factor (CRF) values for all groups. P < 0.0001 for sutured and glued groups vs. non-augmented groups
Fig. 3
Fig. 3
Confocal images of the cornea of unoperated eyes at a depth of approximately 160 μm. Quiescent keratocytes (arrows) appeared as bright oval or bean-shaped objects against a dark background. Cellular processes are not evident. Scale bar: 100 μm
Fig. 4
Fig. 4
Confocal micrographs of both flap edge and peripheral lamellar interface 6 weeks after surgery. Glued and sutured groups (a, b): More bright, dense and more reflective activated keratocytes with elongated cell processes (arrows) populating the flap edge and the peripheral lamellar interface. Unsutured group (c): Less bright and less reflective activated keratocytes with no cell processes (arrows). Scale bar: 100 μm
See this image and copyright information in PMC

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