Clinical outcomes of fibrin glue assisted hemostasis in persistent intraoperative optic disc bleeding

Persistent optic disc bleeding during pars plana vitrectomy (PPV) is difficult to manage. This study aims to explore the use of fibrin glue as a novel agent to achieve hemostasis in such eyes. Interventional case series of patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) due to proliferative diabetic retinopathy, retinal vein occlusion or retinal vasculitis, in whom fibrin glue was used intraoperatively for hemostasis. All the patients were followed up for 1 month. 14 eyes of 14 patients were included, of which 12 (85.7%) were male with mean age of 52 years. Surgery was performed in 10 eyes (71.4%) for VH and 4 eyes (28.6%) for TRD. The mean best corrected visual acuity (BCVA) improved from 1.33±0.53 Logarithm of the Minimum Angle of Resolution (logMAR) (20/428), to 0.42± 0.35 logMAR (20/53) 1 month after surgery (P = 0.002), 0.43± 0.32 logMAR (20/54) 3 months after surgery (p = 0.003) and 0.36±0.34 logMAR (20/46) at a mean of 7 months (p = 0.002) after the surgery. Post operative vitreous cavity hemorrhage occurred in 1 eye (7.1%), which did not require a repeat surgery. This report demonstrates the efficacy of fibrin glue used during vitrectomy in controlling persistent optic disc hemorrhage in a cohort of diverse etiologies. Persistent intraoperative optic disc bleeding is difficult to manage with adverse outcomes. Fibrin glue is a short acting bioadhesive, which has shown favorable outcomes when used in rhegmatogenous retinal detachment and macular hole surgeries. Our prospective interventional study shows that the use of fibrin glue is a valuable technique to manage optic disc bleeders, allowing for better and faster visual recovery, while reducing the incidences of rebleeding and reoperations. Of the 14 eyes included in our study, post-operative vitreous cavity hemorrhage occurred in just one case, which resolved spontaneously, and did not need any reoperation.