Use of Tissue Adhesive for Prevention of Fibrotic Breakdown of Filtration Bleb

Kim, Chang Sik; Ahn, Byung Heon

Abstract

In this experiment using 30 rabbits(40 normal eyes), the applicability of ocular adhesive, HISTOACRYL blue, as an implant beneath the scleral and conjunctival flap. Group 1 consisted of 10 left eyes. These eyes had undergone a fornix-based conjunctival flap and a triangular lamellar scleral flap without sclerectomy and served as a control on histologic examination. Group 2 consisted of 10 right eyes of the rabbits used in group 1. The Histoacryl was pasted on the sclera under the lamellar scleral flap and the conjunctiva. The pasted Histoacryl turned into a thin membrane. Group 3 consisted of 10 right eyes which had undergone a conventional trabeculectomy. Group 4 consisted of 10 right eyes. These eyes had undergone a trabeculectomy and placement of a Histoacryl membrane. The adhesive was applied closely to the limbus in 5 eyes and posteriorly away from the limbus in the remaining 5 eyes of group 4. At the eighth week after operation a filtering bleb was observed in all of the eyes in group In contrast to this, only two eyes showed filtering blebs in group 3. Filtering blebs were so confined over the Histoacryl membrane that their size and location was in accordance with the membrane. The vessels of the conjunctiva overlying the Histoacryl membrane were dilated and congested. This vascular congestion lasted long. The light microscopic examinations of the operation site showed a thick layer composed of macrophages, eosinophils, neutrophils, foreign body giant cells, and fibroblasts surrounding the Histoacryl membrane with cystic space between them. At the eight postoperative week, this wall remained thick measuring about 50-70 micro thick. From the result, Histoacryl appeared to be effective in preventing the fibrotic scarring down of the filtering bleb, but postoperative inflammatory changes indicated that the Histoacryl seemed to be rather unsuitable for clinical application.