A modified surgical technique of fibrin glue-assisted double bipedicle conjunctival flaps for patients with ocular surface diseases

Jen-Yu Liu; Wei-Lun Huang; Yun-Han Hsieh; Jo-Hsuan Wu; Chien-Jung Huang; Wei-Li Chen

doi:10.4103/tjo.tjo_14_22

A modified surgical technique of fibrin glue-assisted double bipedicle conjunctival flaps for patients with ocular surface diseases

Taiwan J Ophthalmol. 2022 May 13;13(1):75-79. doi: 10.4103/tjo.tjo_14_22. eCollection 2023 Jan-Mar.

Authors

Jen-Yu Liu¹, Wei-Lun Huang^{1

2}, Yun-Han Hsieh¹, Jo-Hsuan Wu³, Chien-Jung Huang^{1

4

5}, Wei-Li Chen^{1

6

7}

Affiliations

¹ Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Ophthalmology, National Taiwan University Biomedical Park Hospital, Hsinchu, Taiwan.
³ Department of Ophthalmology, Shiley Eye Institute and Viterbi Family, University of California, San Diego, California, USA.
⁴ Department of Ophthalmology, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan.
⁵ School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
⁶ Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Advanced Ocular Surface and Corneal Nerve Regeneration Center, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

This study aimed to describe and investigate the surgical outcome and complications of fibrin glue-assisted double bipedicle conjunctival flaps (CFs) (FADCOF), an alternative surgical technique that restores a stable ocular surface in patients with painful blinding ocular surface disease combined with a shortage of bulbar conjunctiva. Six eyes of six patients with painful blinding ocular surface disease were enrolled in this study. All patients had inadequate superior or inferior conjunctiva tissue to cover the whole corneal surface owing to previous surgeries or ocular surface diseases. These patients received FADCOF between 2009 and 2019. The main outcome included surgical success rate, visual analog scale (VAS) pain score, ocular inflammation score, and postoperative complications. Surgical success was defined as resolution of initial ocular complaints and restoration of a stable ocular surface with no flap melting, retraction, or dehiscence resulting in re-exposure of the corneal surface. All of the six eyes (100%) achieved surgical success. All patients reported significant improvement in subjective symptoms and complete resolution of ocular pain after the surgery (VAS pain score: 6.5 ± 0.5 preoperatively to 0.0 ± 0.0 at 1 month). Ocular inflammation score decreased significantly from a presurgical value of 1.83 ± 0.69 to 0.33 ± 0.47 1 month after the surgery. No postoperative complication was found during the long-term follow-up (range: 12-82 months). FADCOF is a reliable alternative for patients with painful blinding ocular surface diseases unsuitable for single total CF surgery. This surgical technique yields fast ocular surface stabilization, satisfactory recovery, and low complication rates.

Keywords: Conjunctiva; fibrin tissue adhesive; surgical flaps.