Descemet-Stripping Endothelial Keratoplasty Using Polyethylene Glycol Hydrogel Sealant for Closure of Corneal Incisions in Patients With Prior Glaucoma Surgery
To describe a new surgical technique that maximally preserves conjunctival tissue in glaucoma patients, in which polyethylene glycol hydrogel is used to seal the main corneal incision and allow maintenance of air in the anterior chamber.
The FDA approved polyethylene glycol (PEG) hydrogel (ReSure Sealant, Ocular Therapeutix, Inc.) was used to seal a noncataract 4.2 mm temporal incision in 3 patients with prior Baerveldt Glaucoma Drainage Implant who underwent DSEK surgery at the Bascom Palmer Eye Institute between February-April, 2014. The 4.2 mm temporal incision was sealed using the PEG hydrogel alone and a bandage contact lens (14 or 18 mm) was placed at the conclusion of the procedure. Patients were evaluated at 1 day, 1 week, and 1 month postoperatively to assess for wound integrity, intraocular pressure, graft adhesion and centration.
There were no intraoperative complications. At postoperative day 1, week 1, and month 1 the anterior chamber was formed, no leakage through the main wound was documented and the graft was attached and centered in all patients. Air was present in the anterior chamber of all 3 patients on postoperative day 1, with a mean anterior chamber air fill of 33.3%. Mean postoperative IOP values were 11.3 ± 7.09 mmHg at day 1 and 14.6 ± 0.57 mmHg at week 1 after surgery. Patients tolerated the PEG hydrogel well with no change in adjacent conjunctival architecture in all 3 patients.
The use of polyethylene glycol hydrogel in closure of corneal incisions in patients with prior glaucoma surgery is safe and may preserve conjunctival tissue, minimize disruption of existing blebs, shorten surgery, and avoid the need for removal of sutures which is both time consuming and has potential for complications.