Ophthalmology Update - Cleveland Clinic

Briefly, after everting the eyelid, the tissue is grasped
within a putterman ptosis clamp and two locking
0.5 forceps are placed beneath the clamp to maintain
the relationship of the wound edges. then, half
of the tissue in the clamp is excised, cautery is used
to achieve hemostasis, the wound edges are held in
approximation and the tissue glue is placed onto the
dry field. then the same steps are repeated after the
remaining half of the tissue is excised.
the glue sets within several minutes, and the eyelid
retractor is removed after checking wound security.
the site is dressed with antibiotic ointment. total
time for the procedure is about eight minutes per
side, which represents a slight reduction in time
compared with when the procedure is performed
using suture closure.
“average surgical time for the standard procedure is
only about 11 minutes, and so increased efficiency is
not a major advantage of the sutureless procedure,”
notes dr. perry. Without question, however, there is
less bleeding intraoperatively when the fibrin
sealant is used, and as a result, ecchymoses and
swelling are reduced postoperatively and resolve
more quickly.
“When patients return for their postoperative visit
after 1 week, most have minimal bruising and swelling.
there is some evidence that the fibrin sealant
may accelerate healing by promoting fibroblast proliferation
and accumulation of vascular endothelial
growth factor, and it is likely that when a suture is
placed, fluid remains trapped in the eyelid until the
suture is removed,” notes dr. perry.
Occasionally, patients who undergo sutureless ptosis
surgery may experience a brief episode of conjunctival
bleeding 4 to 5 days postoperatively. the event is
painless and its onset appears consistent with the
timing of degradation of the fibrin sealant.
the fibrin sealant is derived in part from a human
plasma donor pool. manufacturing protocols incorporate
rigorous testing and vapor heat viral inactivation,
and to date there are no known reported cases
of viral or prion disease associated with use of the
product since the manufacturer introduced pcr
viral screening methodology. nevertheless, a risk of
infectious disease transmission cannot be excluded.
“this information is provided to patients and they are
given the option of sutureless or standard surgery.
however, because of its various benefits, we consider
use of the fibrin sealant the method of choice in
patients at increased risk for bleeding or suture
morbidity as well as for patients undergoing
cosmetic ptosis repair who would especially appreciate
a faster and more comfortable course of healing,”
dr. perry says.
i n v e s t i g a t i O n s
For more information, contact
Julian D. Perry, M.D., at
perryj1@ccf.org.
c O l e e y e i n s t i t U t e c l e v e l a n d c l i n i c . O r g / e y e //