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Giulia Corradetti, Scott Mai, Kenneth Wright; Adhesion Force of Extraocular Muscles to Sclera Using N-Butyl-2-Cyanoacrylate Glue. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2432.
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© 2017 Association for Research in Vision and Ophthalmology.
Standard extra-ocular muscles (EOM) recession requires suturing the muscle to sclera. The intra-scleral pass is difficult and dangerous because sclera posterior to rectus muscles insertions is thin, measuring 0.3 mm. Scleral perforation is well-recognized complication of strabismus surgery. The rate of scleral perforation is variable (~ 0.68%-5.1%). Severe sequelae include isolated retinal scars, retinal and vitreous hemorrhages, retinal detachment, endophthalmitis, blindness. Purpose of this study is to investigate the effectiveness of N-Butyl-2-Cyanoacrylate to re-attach muscles to sclera, in order to avoid the intra-scleral needle pass.
Fresh frozen bank muscle-scleral specimens were used to simulate rectus muscle recession in randomized experimental study. 14 rectus muscles were secured with 5.0 Mersilene (©Ethicon, INC 2007) suturing over the Wright Grooved Hook (Titan Surgical Co). Muscles were detached with Westcott scissors then sutures were glued to sclera with either N-butyl-2-cyanoacrylate glue alone in Group 1 or glue over a prolene mesh (VentrioTM Hernia Patch; 4x6 mm) in Group 2. Adhesion force of the muscle suture to sclera was measured using a tension strain gauge (PCE-FM50 CE). The primary outcome was adhesive force required to detach muscle sutures from sclera. We compared the peak detachment force in Group 1 and 2 at 30 seconds. Adhesion force of Group 2 was measured also at 20 and 40 seconds, in order to assess the least surgical waiting time to obtain the polymerization. Statistical analysis was performed using t-test.
In Group 2 (glue + mesh) peak detachment force measured at 30 seconds, was 352.25 gr (SD ± 69.7) versus 193 gr (SD ± 44.5) in Group 1 (p-value < 0.05).Mean adhesive force of N-Butyl-2-Cyanoacrylate over mesh measured 130 gr at 20 seconds versus 315 gr at 30 seconds (p-value < 0.05). There was no significant difference between adhesive force measured either at 352.25 (SD ± 69.7) and 40 seconds (384 gr ± SD 52.1), in Group 2.
N-Butyl-2-Cyanoacrylate glue with prolene mesh resulted in a significantly better muscle-suture to sclera adhesion than glue alone. Adequate adhesion was obtained at 30 seconds or longer, indicating a surgical wait of at least 30 seconds. Use of glue and mesh to secure muscle-suture to sclera is a valuable alternative to needle suturing.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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