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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
  • Valid for credit through: 11/21/2012
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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:

  1. Distinguish the most important intervention to improve wound healing after an eye injury or surgery
  2. Compare cyanoacrylate and fibrin glues in ocular surgeries
  3. Evaluate novel tissue adhesives under investigation for use in ocular surgeries
  4. 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.


Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Expert Reviews Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

    Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

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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

CME Released: 11/21/2011

Valid for credit through: 11/21/2012

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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.