Free Electron Laser-Treated Tisseel Aids Closure of Trabeculectomy Leaks

(Wrk-P-3-07)

K.M. Joos, J.H. Shen, F.Y. Shieh, K. Topadze, V.A. Casagrande  

Vanderbilt University, Nashville, TN

Purpose. The free electron laser (FEL) at Amide Band III wavelength (7.7 $\mu$m) has been shown to be more effective at cutaneous contraction than the CO₂ laser. Therefore, this wavelength may be effective in closing trabeculectomy leaks. Methods. Trabeculectomies were performed on 14 rabbits. A leaking hole was punctured in the bleb and closed randomly with one of 7 techniques: suture, glue, Tisseel, Tisseel + glue, FEL @ 7.7 $\mu$m, Tisseel + FEL @ 7.7 $\mu$m, or Tisseel + FEL @ 7.5 $\mu$m (control flanking wavelength). The FEL was delivered through a hollow waveguide at 2 mJ. The healing characteristics were followed for 1 month. Acute trabeculectomies, bleb holes, and closures were performed on the contralateral eyes immediately prior to euthanasia. All trabeculectomies were examined histologically with serial sections. Results. At 1 week, all suture treatments, and Tisseel combined with FEL @ 7.7 $\mu$m treatments, as well as one glue alone treatment showed complete healing. The others had holes with incomplete healing of the conjunctiva. Conclusions. In a rabbit model, faster healing occurred with suture, or application of Tisseel combined with FEL treatment @ 7.7 $\mu$m. Tisseel treated with low FEL energy at 7.7 $\mu$m appears useful in sealing leaking trabeculectomies.