Conjunctiva in strabismus surgery - to stitch or to stick? - A randomized clinical trial

PURPOSE

To evaluate the clinical outcomes with fibrin glue in comparison with vicryl sutures for limbal conjunctival wound closure in strabismus surgery.

METHODS

In this prospective interventional study, patients undergoing horizontal muscle strabismus surgery were randomized into two groups: the vicryl suture group and the fibrin glue group. The limbal conjunctival incisions were closed with 8-0 vicryl in the suture group and with fibrin glue in the other group. The outcomes measured were post-operative conjunctival inflammation and wound apposition, patient comfort with the help of a questionnaire, and conjunctival thickness using anterior segment optical coherence tomography (AS-OCT) for both groups at 6 weeks.

RESULTS

The study included 64 eyes of 64 patients (32 eyes in each group). The fibrin glue group performed better than the vicryl suture group for most of the symptoms like redness, irritation, watering, and foreign body sensation till 2 weeks post-operatively ( P < 0.001), after which both the groups performed similarly. As for clinical signs, no significant difference was noted between the two groups, except for conjunctival hyperemia, which was significantly lesser in the fibrin glue group at 2 weeks post-operatively ( P < 0.001). The conjunctival thickness measured at 6 weeks using AS-OCT revealed that the thickness increased significantly in the suture group compared to that in the glue group ( P < 0.001 medial site, P = 0.004 lateral site).

CONCLUSION

Because of greater patient comfort and reduced inflammation associated with fibrin glue, it may be considered as a procedure of choice for conjunctival wound closure in strabismus surgery in the absence of the cost constraints.

Comparison of peripapillary capillary plexus using optical coherence tomography angiography and retinal nerve fibre layer analysis using spectral domain optical coherence tomography in glaucoma patients, glaucoma suspects, and healthy subjects

Purpose

To assess the association between radial peripapillary capillary (RPC) plexus using optical coherence tomography angiography (OCTA) and retinal nerve fibre layer (RNFL) thickness using spectral domain OCT (SD-OCT) in primary open-angle glaucoma (POAG) patients, glaucoma suspects, and healthy subjects.

Methods

In this single-centre cross-sectional observational study, POAG, glaucoma suspects, and healthy patients underwent OCT-RNFL and optic nerve head angiography scans. The RNFL thickness and the vascular parameters obtained from RPC plexus, including perfusion density (PD), flux index (FI), and vessel density (VD), were analysed.

Results

In all, 120 eyes of 120 patients, including 40 POAG patients, 40 glaucoma suspects, and 40 healthy subjects, were included. The pairwise comparison of mean RNFL thickness, FI, and VD showed significant difference (P < 0.001) in all sectors between POAG, glaucoma suspects, and healthy eyes. However, PD showed no significant difference between glaucoma suspects and healthy eyes. The average RNFL thickness was found to have a better diagnostic ability than VD to distinguish POAG eyes from healthy eyes and glaucoma suspects based on receiver operating characteristics curve and area under the curve. VD had better diagnostic accuracy than RNFL when glaucoma suspects and healthy were compared.

Conclusion

OCT-RNFL has better diagnostic capability in differentiating glaucoma from healthy eyes compared to OCTA. However, OCTA was found to be better in screening out glaucoma suspects from healthy eyes. The VD is a better OCTA parameter than FI and PD to differentiate POAG and glaucoma suspects from healthy eyes.

Retrospective Study of Visual Outcomes and Complications After Sutureless, Flapless, and Glueless Intrascleral Fixation of Posterior Chamber Intraocular Lens in Children and Young Adults

PURPOSE

To evaluate the visual outcomes and complications after sutureless, flapless, and glueless intrascleral fixation of a posterior chamber intraocular lens (IOL) in patients between the ages of 5 and 20 years.

METHODS

Children with gross subluxated lenses and aphakia following intracapsular cataract extraction with inadequate posterior capsular support underwent intrascleral fixation of a standard three-piece posterior chamber IOL without sutures, flaps, or glue. A retrospective study of 15 eyes of 11 patients with a mean follow-up period of 6 months was performed. The main outcome measures were improvement in visual acuity (best corrected [BCVA] and uncorrected [UCVA]) and early and late postoperative complications.

RESULTS

Preoperative to postoperative mean UCVA changed from 1.34 ± 0.35 to 0.36 ± 0.18 logarithm of the minimum angle of resolution (logMAR), respectively (P < .001). Preoperative to postoperative mean BCVA changed from 0.69 ± 0.37 to 0.19 ± 0.19 logMAR, respectively (P < .001). Two patients showed early postoperative complications within 1 week. One patient presented with vitreous hemorrhage and the other with hyphema on postoperative day 1. Both patients were treated conservatively and recovered by the first follow-up visit. None of the patients showed late postoperative complications during the 6-month follow-up period. The final visual outcome between the complication (n = 2) and no complication (n = 13) groups showed no statistically significant difference (P = .91). The final visual outcome between the eyes with primary and secondary implantation was similar with no statistically significant difference (P = .857).

CONCLUSIONS

The technique of flapless, glueless, and sutureless scleral fixation of a three-piece IOL has shown significant improvement in visual acuity and does not cause significant complications postoperatively. [J Pediatr Ophthalmol Strabismus. 2017;54(6):381-386.].