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A. Shrivastava, H. Engel; An Analysis of Wound Strength in Posterior Scleral Rupture Repair: Imbricated versus Interrupted Suturing With the Adjunctive Use of Bioglue Tissue Adhesive. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3452.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the burst pressure of posteriorly lacerated globes repaired with either imbricated or interrupted suturing techniques. To further determine if Bioglue biological adhesive is a useful adjunctive therapy for wound closure.
24 porcine eyes were equatorially lacerated to acheive a 1 cm. full thickness linear scleral wound. Twelve eyes were repaired using eight equadistant 8-0 Nylon sutures for end to end closure. The remaining twelve eyes were repaired using four 5-0 Dacron mattress sutures placed 1.5mm from the wound edge for imbricated closure. The eyes were randomized, and both an infusion port and monometer port were placed on both sides of the wound and sealed using a commercial adhesive. Colored saline was then infused at a rate of 5ml/minute. The monometer digitally displayed the intraocular pressure during the infusion, and the burst pressure was recorded for each eye. The burst pressure was defined as the pressure at which the colored saline was first detected externally from the repaired laceration. For eyes with burst pressures below 50mm Hg, BioGlue adhesive was then additionally placed over the wound, and allowed to cure for 2 minutes. The burst pressure of the these eyes was then recorded using the same criterion.
There was no significant difference in the overall burst pressure of eyes repaired with imbricated sutures versus interrupted sutures (p = 0.366). In the subset of eyes from both groups that had a burst pressure of less than 50 mm Hg, the eyes closed with imbricated sutures maintained a significantly higher burst pressure (mean = 35.5mm Hg) than those eyes closed with interrupted sutures (mean = 12.5 mm Hg) (p < 0.01). Furthermore, in the subset of eyes from both groups that received BioGlue, these eyes maintained a significantly higher pressure (mean = 75.0 mm Hg) than unglued eyes (mean = 15.5 mm Hg) (p < 0.01).
Imbricating suturing technique for traumatic posterior scleral rupture provided a significant improvement in burst pressure when compared to eyes repaired with interrupted closure when post-repair pressures were less than 50mm Hg. The adjunct use of BioGlue adhesive significantly improved these wound strengths up to intraocular pressures of 75mm Hg.
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