A Scaffold-Enhanced Laser-Activated Surgical Adhesive Technique for Sutureless Strabismus Surgery

Abstract

Abstract: : Purpose: We investigated a scaffold-enhanced laser-activated bioadhesive technique as a substitute for sutures in strabismus surgery. Methods: The bioadhesive was composed of a poly(L-lactic-co-glycolic acid) (PLGA) porous scaffold doped with a protein solder mix composed of bovine serum albumin (BSA) and indocyanine green (ICG), which was activated with an 808nm diode laser. Extraocular muscle-to-muscle and extraocular muscle-to-sclera adhesions were created in freshly-harvested tissue followed by tensile strength testing of these surgical adhesions. Results: Optimum tensile strength for muscle-to-muscle repair was achieved with 50% w/v BSA and 0.5mg/ml of ICG saturated into a PLGA porous scaffold and activated with an 808nm diode laser. Tensile strength was 81% of native muscle tensile strength (433 + 70g vs. 494 + 73g). Rectus muscle-to-sclera was 309 + 37g, much greater than the reported actively developed horizontal fixation force measured in vivo in humans. Conclusions: Suture use in strabismus surgery can be technically-demanding, time-consuming and may be associated with serious complications, such as endophthalmitis resulting from inadvertant scleral perforation. Handling of fine needles may expose operating room personnel and physicians to needle-stick injuries and transmission of serious diseases. Bioadhesive surgery could eliminate many complications and limitations associated with the use of sutures. We have demonstrated that the immediate tensile strengths achieved with a scaffold-enhanced laser-activated solder for muscle-to-muscle and muscle-to-sclera adhesions are, respectively, similar to or greater than those physiologically required for strabismus surgery.

Keywords: strabismus: treatment • wound healing • strabismus