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A. G. de Alba Campomanes, A. K. Lim, D. R. Fredrick; Cyanoacrylate Adhesive Performance in Primary Operation and Reoperation of Extraocular Muscles in a Rabbit Model. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4126.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the performance of 2-octyl-cyanoacrylate compared to 6-0 polyglactin suture in rabbit superior rectus muscle surgery after operation and reoperation.
27 New Zealand White rabbits were randomized to have one eye operated with cyanoacrylate and the other with polyglactin suture. First, the superior rectus was recessed 5 mm, assessing operative time and difficulty. The rabbits were examined at 1, 7, 14, 21 and 28 days after surgery using a clinical inflammatory index score. 5 rabbits were then randomized to tensile strength measurement, 2 to histopathology evaluation and 20 to reoperation. These rabbits underwent superior rectus advancement to 1 mm from the limbus using the same material as in the first surgery for each eye. Ease of reoperation, operative time and inflammatory index were recorded. The slippage distance between the muscle and the original insertion site was measured in all eyes. 32 eyes were then randomized to undergo tensile strength measurement and 8 to histopathological evaluation. For the primary outcomes, the margin of noninferiority used was 1 mm for slippage and 100g for tensile strength, as predetermined during the study design.
In both groups, the proportion of slippage >1 mm from the recession site was 3.7 %. For the reoperation it was 42.1 vs. 26.3% in the suture and cyanoacrylate groups respectively (p = 0.248) and the mean slippage was 0.68 and 0.47 mm (95% CI -0.47 to 0.89 mm, p = 0.536). Mean tension was 842.80g for the suture group and 777.20g for the cyanoacrylate group after the first operation (95% CI -362.77 to 493.97g, p = 0.733) and 877.73g and 844.87g after the reoperation (95% CI -181.31 to 247.04g, p = 0.756). There was no difference between groups for surgical difficulty or inflammatory index scores. Cyanoacrylate surgery was 3.85 min faster than suture on average (p < 0.05). Histopathologically, both groups showed a chronic granulomatous inflammatory reaction.
This study suggests that cyanoacrylate can achieve an adequate muscle-sclera bond in the immediate period after surgery to avoid major slippage, and does not affect the long-term wound healing process. Cyanoacrylate is not inferior to suture both for recession and advancement procedures. It seems to be well tolerated and does not impose more technical difficulty. Given the advantages of faster operative time and no risk of globe perforation, commercially available cyanoacrylate may be a good alternative to suture in strabismus surgery.
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