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.
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CME Released: 11/21/2011
Valid for credit through: 11/21/2012, 11:59 PM EST
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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.
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.