Sutureless ophthalmic surgery: a scaffold-enhanced bioadhesive technique.
OBJECTIVE
Bioadhesives have had limited use in ophthalmic surgery. Problems with these adhesives have included inadequate tensile strength and difficulty with their application to the tissue site. We evaluated a scaffold-enhanced cyanoacrylate bioadhesive composite as an alternative to sutures in ophthalmic surgery, including strabismus procedures.


METHODS
The bioadhesive composite consisted of 2-octyl-cyanoacrylate combined with either a poly(L-lactic-co-glycolic acid) (PLGA) scaffold or a rehydrated porcine small intestine submucosa (SIS) scaffold. Extraocular rectus muscle and sclera were obtained from rabbits (n = 40) and were used, with these bioadhesive composites, to produce rectus muscle-to-sclera, sclera-to-sclera, and rectus muscle-to-rectus muscle adhesions. Control adhesions were created with cyanoacrylate only. The breaking load of the tissue repair was measured with a material strength-testing machine.


RESULTS
In all cases, the scaffold-enhanced cyanoacrylate adhesions were significantly stronger (P < 0.001) than the cyanoacrylate alone. The rectus muscle-to-sclera adhesions were greater than the in vivo forces reported for the horizontal rectus muscles in humans in extreme gaze.


CONCLUSIONS
This scaffold-enhanced bioadhesive composite produced initial muscle-sclera adhesions with strength satisfactory for strabismus surgery. It also may be applicable to other categories of ophthalmic surgery as a substitute for sutures.
Duffy
Mark T
MT
Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Illinois, USA.
Bloom
Jeffrey N
JN
McNally-Heintzelman
Karen M
KM
Heintzelman
Douglas L
DL
Soller
Eric C
EC
Hoffman
Grant T
GT
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use; D019344:Lactic Acid / Q000627:therapeutic use; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011100:Polyglycolic Acid / Q000627:therapeutic use; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers / Q000627:therapeutic use; D011817:Rabbits; D013536:Suture Techniques / Q000295:instrumentation; D013552:Swine; D013718:Tensile Strength; D014014:Tissue Adhesives; D014945:Wound Healing
D001672:Biocompatible Materials; D011108:Polymers; D014014:Tissue Adhesives; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid