1.
Does tranexamic acid improve intra-operative visualisation in endoscopic ear surgery? A double-blind, randomised, controlled trial
Das A, Mitra S, Ghosh D, Kumar S, Sengupta A
The Journal of laryngology and otology. 2019;:1-5
Abstract
OBJECTIVE To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation. METHODS Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear. RESULTS The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences. CONCLUSION Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.
2.
Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft
Malik VK, Kumar S
Saudi Medical Journal. 2010;31((12):):1326-30.
Abstract
OBJECTIVE To evaluate whether use of fibrin glue instead of sutures for the treatment of recurrent pterygium with conjunctival auto-graft (CAG) further decreases its recurrence. METHODS A prospective, clinical open trial of 50 eyes of 50 patients with recurrent pterygium, who were randomly assigned to either, pterygium excision and CAG with fibrin glue (Group 1) or with 6 interrupted sutures (Group 2), was carried out from January 2009 to July 2010 at the outpatient department of Subharti Medical College, Meerut, North India. Both groups had 25 patients each. The groups were compared with regards to the surgical time taken, development of recurrence, postoperative symptoms (irritation, watering, and redness), and complications. RESULTS Recurrence was seen in one (4%) eye in group I, and 3 (12%) eyes in group II after 9-13 months of follow up. The difference between the 2 groups was not statistically significant. The surgical time was significantly reduced, and postoperative inflammation and complications were less in group I. Postoperative symptoms were significantly more in group II patients. CONCLUSION While conjunctival autograft with sutures for management of recurrent pterygium appears to be a safe and feasible modality, fibrin glue fixation of the autograft is a more viable option in terms of surgical ease, less time consuming, less postoperative complications, and less recurrence.
3.
Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations
Sharma A, Kaur R, Kumar S, Gupta P, Pandav S, Patnaik B, Gupta A
Ophthalmology. 2003;110((2):):291-8.
Abstract
OBJECTIVE To compare the efficacy of fibrin glue and N-butyl-2-cyanoacrylate in corneal perforations. DESIGN Randomized, controlled clinical trial. PARTICIPANTS Forty-one patients (41 eyes) with corneal perforations up to 3 mm in diameter with a positive Seidel's test were randomly assigned to two groups (1 and 2). INTERVENTION Group 1 comprised 19 eyes treated with fibrin glue, and group 2 comprised 22 eyes treated with N-butyl-2-cyanoacrylate. MAIN OUTCOME MEASURES Number of eyes with successful healing, time required for healing, status of corneal vascularization, and complications were compared in the two groups. Power calculation was performed at alpha = 0. 05. RESULTS Fifteen (79%) eyes had successful healing of corneal perforation in group 1, compared with 19 (86%) eyes in group 2 (P > 0. 05) at 3 months' follow-up. The power to detect a difference between the two groups was 10%. Corneal perforation healed within 6 weeks in 12 (63%) eyes in group 1 and 7 (31. 8%) eyes in group 2 (P < 0. 05). Reapplication of glue was required in six (31. 5%) eyes in group 1 and seven (31. 4%) eyes in group 2 during the first 3 months of follow-up. The mean number of applications per eye was 1. 37 in group 1 and 1. 36 in group 2. An increase in deep corneal vascularization was observed in 2 (10. 5%) eyes in group 1 and 10 (45. 5%) eyes in group 2 (P < 0. 05). Giant papillary conjunctivitis occurred in one (5%) eye in group 1 and eight (36. 4%) eyes in group 2 (P < 0. 05). CONCLUSIONS Fibrin glue and cyanoacrylate tissue adhesive are both effective in the closure of corneal perforations up to 3 mm in diameter. Fibrin glue provides faster healing and induces significantly less corneal vascularization, but it requires a significantly longer time for adhesive plug formation.