Abstract
Abstract: :
Purpose: The potential benefits of having a bioadhesive as a tool in the management of certain complicated retinal detachments have been recognized for the last four decades, but the technical obstacles have proved daunting. A rapidly gelling synthetic tissue sealant consisting of a polymer of two polyethylene glycol (PEG) derivatives has been approved for clinical use in vascular surgery. Its properties prompted us to evaluate its potential applications in retinal surgery. Methods: Experiments were performed in rabbits using a corneal limbal approach for vitrectomy and lensectomy, in order to obtain access to the retinal surface under clinically–relevant conditions of fluid and air. In our initial experiments, we observed that the PEG glue floats in vitreous, leading to dispersion away from the intended site. Subsequent experiments in air–filled eyes were performed in association with the creation of a retinal break by introducing a 32 gauge needle into the subretinal space and injecting saline. PEG glue was injected and maintained in contact with the retinal break, and the animals were followed by indirect ophthalmoscopy. Additional eyes had simple intravitreal injection of PEG glue in order to evaluate potential retinal toxicity of this substance. Animals were sacrificed at 7–10 days or at 1 month, and the operated eyes were enucleated and fixed in Karnovsky’s fixative, and histopathological evaluation was performed. Results: PEG glue maintained acute contact with the retina and break for several days, and subsequently lifted from the retina surface as fluid returned to the eye. The application could be controlled and directed, and preliminary evaluation disclosed no untoward clinically–evident effects. Conclusions: PEG glue is a novel and promising substance for vitreoretinal applications, and the transient nature of the contact with the retina and its lack of toxicity observed so far may prove advantageous for the treatment of retinal breaks.
Keywords: retinal detachment • pathology: experimental • vitreoretinal surgery