title: Sutureless ophthalmic surgery: a scaffold-enhanced bioadhesive technique.
abstract: 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.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Illinois, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Duffy
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bloom
authors.forename: Karen M
authors.initials: KM
authors.lastname: McNally-Heintzelman
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Heintzelman
authors.forename: Eric C
authors.initials: EC
authors.lastname: Soller
authors.forename: Grant T
authors.initials: GT
authors.lastname: Hoffman
mesh_terms: 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
chemical_list: D001672:Biocompatible Materials; D011108:Polymers; D014014:Tissue Adhesives; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid