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John J Whalen, Yi Zhang, Paulo Falabella, Niki Bayat, Mark E. Thompson, Mark S Humayun; Polymeric Shield to Reduce Conjunctival Scarring and Facilitate Re-Access for Multistage Surgical Procedures.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3042.
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© ARVO (1962-2015); The Authors (2016-present)
Intervention of combat-related open globe injuries is typically managed in two-stages: first the casualty is stabilized at a critical care facility, and later, complete surgical intervention is performed after transportation to a base hospital with full surgical facilities. Casualties wait more than 24 hours before the second, follow-up intervention. We evaluate, in vivo (rabbit), a non-resorbable polymer patch placed sub-conjunctival as a shield to prevent fibrosis before full intervention.
Sub-conjunctival pockets(superior and inferior) were created in one eye (OD) of New Zealand pigmented rabbits by making a 5mm incision 3mm from and tangential to the limbus. A sterile (ETO), flexible polymer substrates (Area: <100mm2) was inserted into the superior pocket as a shield with the conjunctiva drawn back over and held in place with a suture. Examinations for infection or lacerations were conducted daily for 14 days, at which time the implants were removed. Half of the animals were euthanized and the treated eye was enucleated and fixed to compare fibrosis of the superior (patch insert) vs. inferior (no insert) pockets. Remaining rabbits were followed up for two additional weeks (Day-28) with the superior pocket shields removed. At Day-28 the remaining rabbits were euthanized and the treated eyes were enucleated and fixed for histology to assess fibrosis 14-days post-shield removal. This study was conducted in compliance with the ARVO Statement for the Use of Animals in Ophthalmic and Visual Research.
Shield placement caused no irritation or inflammation post-placement. Shield removal at Day-14 caused no additional trauma and post-removal it enabled easy re-access to the scleral surface. Fibrosis at Day-14 showed differences between superior (shielded) and inferior (unshielded) pockets.
Temporary placement of polymeric shields between the sclera and external tissues prevents fibrosis between apposed tissues, allowing easier follow-up access as in the case of two-stage ocular interventions for combat casualties. This research was conducted with support from the Vision Research Program of the United States Telemedicine and Advanced Technology Research Center (TATRC) under contract # W81XWH-12-1-0314 and Research to Prevent Blindness.
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