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M.T. Duffy, J.N. Bloom, D. Edward, M.E. Rosselson, K.M. McNally-Heintzelman; Strabismus Surgery: Scaffold-Enhanced 2-Octyl-Cyanoacrylate Adhesive Versus Sutures . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2749.
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Purpose: Traditional strabismus surgery using sutures may be time-consuming and technically demanding. Inadvertent ocular penetration can lead to serious complications such as retinal detachment and endophthalmitis. We investigated a scaffold-enhanced cyanoacrylate adhesive as an alternative to sutures. Methods: Rabbit (n=12) superior rectus muscles (n=24) were isolated and recessed 4.0 mm from the corneoscleral limbus. Three experimental groups (n=8 muscles each) based on the method of repair were designated : Suture group (6-0 polyglactin), Glue group (2-octyl-cyanoacrylate alone), and Glue + Scaffold group [porous poly(L-lactic-co-glycolic acid) membrane and 2-octyl-cyanoacrylate]; in this last group, the membrane provided a scaffold, between the muscle and the sclera, for the glue. Half of the animals were sacrificed at 2 days and the remainder at 14 days after surgery. At each time point, half of the muscle attachments underwent immediate tensile strength testing and the other half were processed for histologic examination. Results: Tensile strengths were adequate for postoperative adhesion, but variable in both the Suture group and the Glue group. Tensile strength of the Glue+Scaffold group was less variable and above the physiologic requirement for muscle force. Histology at 2 days showed early reattachment in all groups. Inflammation in the Glue and Glue+Scaffold groups was greater than that produced by sutures, but was a localized acute reaction. Clinically all eyes were quiet and healthy at 14 days with no significant difference to examination. Conclusions: Experiments utilizing a scaffold-enhanced bioadhesive to reattach muscles following recession are encouraging. All scaffold-glue attachments maintained tensile strengths above that reported in humans in vivo during extreme gaze. Further investigation into the optimization of application parameters and detailed tensile strength time course studies are planned. Tensile Strength View OriginalDownload SlideView OriginalDownload Slide
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