A New Reabsorbable Carbohydrate Based Tissue Adhesive versus Conventional Nylon Sutures for Sealing Corneal Incisions

Abstract

Purpose: : To compare the effectiveness of a new reabsorbable sealant with conventional nylon sutures for sealing linear corneal incisions.

Methods: : A keratome knife was used to create a 2.75-mm full-thickness linear corneal incision in 40 fresh cadaveric rabbit eyes. The incision was sealed with tissue adhesive (study group n=20 eyes) or closed with 2 interrupted 10-0 nylon sutures (control group n=20 eyes). A 25-gauge needle connected to an infusion system with a balanced saline solution (BSS) and a 27- gauge needle attached to a digital manometer were inserted into the anterior chamber through the limbus 180° away from each other. Intraocular pressure (IOP) was subsequently increased by raising the infusion bag at its maximum height to determine the highest IOP achievable with the experimental setup before any incisions were made. Just before incisions were made, the BBS bag height was adjusted to maintain an approximated IOP of 18 to 22 mm Hg. Wound stability was tested by increasing IOP until wound leakage was observed.

Results: : The mean maximum IOP resisted in the control group was 36.33 ± 7.97 mm Hg (SD), with a range from 28 to 54 mm Hg. In this group all of the eyes (n=20) had leakage. The mean IOP achieved in the study group was 115.62 ± 13.64 mm Hg with a maximum IOP pressure of 124.7 mm Hg reaching the maximum attainable IOP permitted by the experimental setup. In this group 2 eyes had leakage. There was a statistically significant difference of the resisted IOP between the study group and the control group (p<0.0001).

Conclusions: : The tested adhesive was more effective than sutures when used for clear corneal incisions in this animal ex vivo model. The main advantage to utilize this new adhesive is the fact that it is reabsorbable. Furthermore, it is easy and fast to use it and does not require any kind of activation to start working. Hence, this adhesive may be considered as an effective alternative to conventional sutures in corneal wound closure.

Keywords: cornea: basic science • wound healing • intraocular pressure