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Papers of special note have been highlighted as:
• of interest
•• of considerable interest

CME

Tissue Adhesives in Ocular Surgery

Authors: Heyjin C. Park; Ravi Champakalakshmi; Pradeep P. Panengad; Michael Raghunath, MD, PhD; Jodhbir S. Mehta, FRCS (Ed)
CME Released: 11/21/2011
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 11/21/2012, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for ophthalmologists and other physicians who might use tissue adhesives for ocular surgeries.

The goal of this activity is to evaluate the use of tissue adhesives for ocular surgeries.

Upon completion of this activity, participants will be able to:

Distinguish the most important intervention to improve wound healing after an eye injury or surgery
Compare cyanoacrylate and fibrin glues in ocular surgeries
Evaluate novel tissue adhesives under investigation for use in ocular surgeries
Analyze laser welding and laser soldering in ocular surgeries

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Heyjin C. Park

Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore

Disclosures

Disclosure: Heyjin C. Park has disclosed no relevant financial relationships.

Ravi Champakalakshmi

Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore

Disclosures

Disclosure: Ravi Champakalakshmi has disclosed no relevant financial relationships.

Pradeep P. Panengad

Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute; Division of Bioengineering, Faculty of Engineering, National University of Singapore, Singapore

Disclosures

Disclosure: Pradeep P. Panengad has disclosed no relevant financial relationships.

Michael Raghunath, MD, PhD

Division of Bioengineering, Faculty of Engineering, National University of Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Disclosures

Disclosure: Michael Raghunath, MD, PhD, has disclosed no relevant financial relationships.

Jodhbir S. Mehta, FRCS (Ed)

Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute; Singapore National Eye Centre; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore

Disclosures

Disclosure: Jodhbir S. Mehta, FRCS (Ed), has disclosed no relevant financial relationships.

Editor(s)

Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD

Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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For Physicians

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From Expert Review of Ophthalmology

CME

Tissue Adhesives in Ocular Surgery

Authors: Heyjin C. Park; Ravi Champakalakshmi; Pradeep P. Panengad; Michael Raghunath, MD, PhD; Jodhbir S. Mehta, FRCS (Ed)Faculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 11/21/2011

Valid for credit through: 11/21/2012, 11:59 PM EST

processing....

Abstract and Introduction

Abstract

Tissue adhesive sealants have been used as substitutes for sutures in ophthalmic surgery in recent years since the latter may cause irritation, inflammation and infection. Tissue adhesives were developed as suture adjuncts and alternatives for sealing wounded tissues. They are gaining popularity for their ease of use and postoperative comfort. Two broad classes of tissue adhesives, synthetic and biological, have been reported in previous studies. Cyanoacrylate-based synthetic tissue adhesives have been conventionally used for corneal perforation surgeries. Fibrin glue is a bioadhesive developed from blood plasma. Aside from these surface sealants, a new class of compounds termed biodendrimers has also found a use in ophthalmic surgery. Other adhesives in development include acrylic-based adhesives, polyethylene glycol hydrogels, chondroitin sulfate, riboflavin-fibrinogen compounds, photoactivated serum albumin solder and photo-polymerized hyaluronic acid compounds. This article aims to cover the therapeutic uses and application techniques of the aforementioned tissue adhesives in ophthalmology.

Introduction

The application of tissue adhesives in ophthalmology started as early as the 19th century.^[1] The first surgical application of tissue adhesive was described by performing sutureless ocular surgery in rabbits using methyl-2-cyanoacrylate.^[2] Later, from the start of the 20th century, various other tissue adhesives were invented and used in ophthalmology. The drive towards the development of an adhesive comes from the complications associated with suturing. These include postoperative discomfort, prolonged healing time, risk of infection as well as prolongation of surgical time, and scarring.

Properties of ideal tissue adhesives include postoperative comfort, cost—effectiveness, rapid setting time and transparency, high tensile strength by creating a strong bridge between wounded margins, easy application, biodegradable and biocompatible. Currently there are two main classes of tissue adhesives: synthetic (e.g., cyanoacrylate and acrylic-based polymers), and biological (e.g., fibrin glue, biodendrimers and riboflavin—fibrinogen compounds). Newly modified adhesives (e.g., chondroitin sulfate [CS] polymer and laser-activated serum albumin adhesive) have been described more recently in ophthalmology. Each of these adhesives has their own advantages and disadvantages. In this article, we shall discuss the uses and applications of the most commonly used tissue adhesives (i.e., cyanoacrylate and fibrin glue) and the recent developments with regard to newly described bioadhesives.

Page 1 of 11

Cyanoacrylate & Acrylic-based Tissue Adhesives

CME Information

Abstract and Introduction
Cyanoacrylate & Acrylic-based Tissue Adhesives
Clinical Uses
Fibrin Glue
Application Techniques
Safety of Fibrin Glue
Investigatory Adhesives
Tissue Transglutaminase Glue
Expert Commentary
Five-year View
Key Issues

References

References

Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Author(s)

Heyjin C. Park

Ravi Champakalakshmi

Pradeep P. Panengad

Michael Raghunath, MD, PhD

Jodhbir S. Mehta, FRCS (Ed)

Editor(s)

Elisa Manzotti

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

CME

Tissue Adhesives in Ocular Surgery

Target Audience and Goal Statement

Disclosures

Author(s)

Heyjin C. Park

Ravi Champakalakshmi

Pradeep P. Panengad

Michael Raghunath, MD, PhD

Jodhbir S. Mehta, FRCS (Ed)

Editor(s)

Elisa Manzotti

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Tissue Adhesives in Ocular Surgery

Abstract and Introduction

Abstract

Introduction

Table of Contents