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Ronald L. Rebenitsch, Savak Teymoorian, Daryl L. Goad, Peter Koulen, Rohit Krishna; Tensile Strength of Potentially Clinically Relevant Tissue Adhesives for Clear Cornea Incisions: In Vitro Assessment in Bovine Eyes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):369.
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Suturing is a time-intensive and potentially complication-ridden component of ophthalmic surgery. Adhesives and sealants, biologic and non-biologic, have been used throughout medicine as alternatives to suturing. Numerous comparisons of different types of adhesives with respect to surgical outcome parameters have been reported in case studies and small-scale clinical trials. Intraocular and extraocular inflammation with biologic based adhesives has been shown to be minimal as has extraocular inflammation with non-biologic adhesives. The goal of the present study was to assess the tensile strength of tissue adhesive and to contribute to our knowledge about suture-less methods of wound closure in ophthalmic surgeries.
Limbal clear cornea incisions, 2.5 mm in size, identical to those used in a phacoemulsification procedure were performed on twenty six freshly isolated bovine cadaver eyes, one on each eye. Thirteen eyes were closed with 10-0 nylon suture (Ethilon, Ethicon, San Angelo, TX). The incisions on the remaining eyes were closed with superficial application of 2µl cyanoacrylate based tissue adhesive (LIQUIVET RAPID, Oasis Medical, Mettawa, IL). Wound integrity was then measured using hydrostatic elevation of intraocular pressure (IOP) with optical monitoring of wound closure and of fluid leakage. The pressure at which the integrity of the wound closure failed IOP was measured intraocularly with a manometer (Omega Model HHP91,Omega Engineering, Inc., Stamford, CT) and by applanation tonometry (TONO-PEN XL, Reichert Ophthalmic Instruments, Depew, NY). The effects of IOPs from 20-120 mmHg were recorded in increments of 10 mmHg for 1 min each and integrity at the maximally measured IOP (120 mmHg) was monitored for 15 min.
The integrity of the wound closure of all thirteen eyes sealed with the cyanoacrylate based adhesive was maintained at 120 mmHg for the total period of observation (15 min), at which point, however, the integrity of the other tissues of the bovine cadaver eyes began to be breached in the form of visible tears in the sclera. The breach of the wound closure of the 13 incisions closed with a 10-0 nylon simple suture occurred at 85 ± 9 mmHg.
Given the superior tensile strength of wound closure, the relatively benign nature, and the likely improved efficiency of surgical procedures, we conclude that tissue adhesives could have a greater role in ophthalmic surgery than they do now.
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