Intraoperative use of fibrin glue in blepharoplasty: a possible solution to reduce postoperative complication

Abstract

The purpose of this study was to investigate the effects of intraoperative fibrin glue use on surgery for blepharoptosis. This retrospective study included patients with acquired blepharoptosis who underwent surgical correction and were followed for at least one month. Patients were classified into two groups depending on whether treated with antithrombotic agents or otherwise. All patients taking antithrombotic agents discontinued with the treatment one week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1(MRD1) and ecchymosis grade were evaluated and compared. The subjects were 56 patients (111 eyes) who discontinued antithrombotic agents before surgery and 59 patients (117 eyes) who had never taken antithrombotic agents. Fibrin glue was used in 13 patients (26 eyes, 23.4%) in the antithrombotic group, and 11 patients (21 eyes, 17.9%) in the non-antithrombotic group. The rate of severe ecchymosis was significantly lower in patients who used fibrin glue in the antithrombotic group at 1 week (11.5 vs 40.0%, p = 0.008). However, in non-antithrombotic group, there was no difference in the rate of severe ecchymosis according to the use of fibrin glue at 1 week (14.3 vs 30.2%, p = 0.181). In patients with a history of taking antithrombotic agents, the intraoperative use of fibrin glue is thought to be helpful as it could significantly reduce significant ecchymosis.

Figure 1

Photographs of a patient who underwent surgery for blepharoptosis. (A) Intraoperative photograph shows a procedure of applying fibrin glue to the surgical site before skin suturing. (B) Photograph after removing fibrin glue shows that rapid and effective hemostatic effect without significant additional bleeding.

Figure 2

Photographs of example of postoperative ecchymosis grade. (A,B) Grade 0 and 1: no bruise or mild bruise (less than 1/2 of periorbital area). It is defined as ‘mild ecchymosis group’. (C)(D) Grade 2 and 3: moderate to severe bruise with dark purple color (more than 1/2 of periorbital area). It is defined as ‘severe ecchymosis group’.