title: Sutureless sealing of penetrating corneal wounds using a laser-activated thin film adhesive.
abstract: OBJECTIVE
  To demonstrate the feasibility of a novel, thin film, laser-activated adhesive in sealing penetrative corneal wounds with a view to replacing sutures in ophthalmic operations.
  
  
  METHODS
  A previously described thin film adhesive composed of chitosan and indocyanine green activated by infrared laser (808 nm) was used to seal penetrating corneal wounds ranging from 1 to 6 mm in size in enucleated bovine eyes. The excised corneas were subjected to pressure tests to evaluate the strength of the corneal repairs and compared to sutures and commercial fibrin glue, Tisseel®. Temperatures at the adhesive-tissue interface were measured and histological examinations of the repairs performed to investigate potential tissue damage. Biodegradability of the films was monitored in lysozyme solutions at concentrations reported in tears.
  
  
  RESULTS
  The adhesive effectively sealed corneal wounds, withstanding pressures of 140-320 mmHg, far in excess of the normal intraocular pressure. In contrast, pressures of 40-80 mm Hg were determined using a combination of sutures with Tisseel® as a sealant. The laser-activation process was 1.5-5 times faster than other procedures studied and required no curing time. A transient, mean temperature of 56 ± 2°C was measured at the adhesive-tissue interface while histology showed no tissue damage as a consequence of the irradiation process. Irradiation had no significant influence on adhesive biodegradation in vitro, which lost approximately 30% of their initial weight in a lysozyme solution (6 mg ml(-1)).
  
  
  CONCLUSIONS
  The thin film adhesive was found to be an effective in sealing corneal wounds with considerable advantages over sutures, including speed of application and sealing strength and biodegradability.
authors.affiliation: Bio/Polymer Research Group, Centre for Advanced Macromolecular Design, School of Biotechnology & Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Jeyran
authors.initials: J
authors.lastname: Shahbazi
authors.forename: Helder
authors.initials: H
authors.lastname: Marçal
authors.forename: Stephanie
authors.initials: S
authors.lastname: Watson
authors.forename: Denis
authors.initials: D
authors.lastname: Wakefield
authors.forename: Maria
authors.initials: M
authors.lastname: Sarris
authors.forename: L John R
authors.initials: LJ
authors.lastname: Foster
mesh_terms: D000818:Animals; D002417:Cattle; D048271:Chitosan; D065306:Corneal Injuries; D057112:Corneal Perforation / Q000628:therapy*; D005240:Feasibility Studies; D007208:Indocyanine Green; D053685:Laser Therapy; D014014:Tissue Adhesives
chemical_list: D014014:Tissue Adhesives; D048271:Chitosan; D007208:Indocyanine Green