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Anthony James Johnson, Timothy Soeken, Mirang Kim, Heuy-Ching Hetty Wang, sheri DeMartelaere, Irene E Kochevar; Sealing of Corneal and Scleral Lacerations Using Photo-Activated Rose Bengal Dye and Amniotic Membrane. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1596.
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When the eye sustains a laceration that perforates the cornea or sclera it is incumbent that the ophthalmologist performs an immediate watertight closure to prevent infection and to prevent the ingress of epithelial cells into the eye. The standard of care is to close the laceration with sutures. In cases in which the cornea is too damaged for suture closure, the surgeon often needs to use cyanoacrylate glue, or other non-FDA approved device to get a water tight seal. In this study we seek to validate a sutureless technology for sealing complex corneal and scleral lacerations that bonds amniotic membrane to the wound using only green light and an FDA approved vital dye (Rose Bengal).
60 New Zealand White Rabbits were included in this study. In the first arm, the right eye of 15 New Zealand rabbits were subjected to a 4mm V shaped central corneal laceration. One suture was placed to re-approximate the stromal surfaces. Amniotic membrane was impregnated with rose Bengal dye, then crosslinked to the ocular surface to achieve a water-tight seal. The left eyes were untreated to serve as controls. These were compared to 15 rabbits in which an identical incision was placed and closed by 10-0 nylon suture. In the second arm of the study, the right eyes of 15 rabbits were subjected to a 4mm corneal-scleral laceration centered on the limbus. One suture was placed to re-approximate the stromal surfaces. Amniotic membrane was impregnated with rose Bengal dye crosslinked to the ocular surface. The left eyes were untreated to serve as controls. These were compared to 15 rabbits in which an identical incision was placed and closed by nylon sutures in the standard fashion. The rabbits were clinically evaluated for 28 days, then sacrificed for histopathological analysis.
Histopathological analysis was performed using a 5 point grading system, to evaluate the edema, epithelial degeneration, endothelial necrosis, inflammation (acute and chronic) and the presence of neovascularization. The results were then analyzed utilizing an ANOVA with Tukey adjustment. Preliminary results revealed no significant difference between the groups.
The results of these studies established that a light-activated method to crosslink amniotic membrane to the cornea can be used for sealing complex penetrating wounds in the cornea, and the sclera, with minimal inflammation, or secondary effects.
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