Evaluation of nano-structured, dexamethasone-eluting suture handleability for ocular trauma repair

Abstract

Purpose : Inflammation and scarring lead to poor visual prognosis following open-globe injuries. Drug-loaded sutures have potential to both repair wounds and deliver an anti-inflammatory agent directly at the surgical site to modulate healing and improve outcomes. We utilized a novel, electrospinning-based technique to manufacture dexamethasone sodium phosphate (DSP)-loaded sutures and tested their handleability in comparison to conventional nylon and Vicryl sutures in ex vivo porcine eyes

Methods : Aligned nanofibers were electrospun from a solution of 8% (w/w) DSP and 12% (w/w) polycaprolactone (PCL) in hexafluoroisopropanol. Fibers were twisted and processed to form a multifilament suture and characterized for breaking strength, diameter, and morphology prior to evaluation during the Ocular Trauma Skills Laboratory at the Uniformed Services University. 14 ophthalmologists with expertise in ocular trauma made a 5 mm corneal incision in porcine eyes (n=3) followed by closure with 10-0-sized nylon, Vicryl, or PCL/DSP sutures in random order. Participants rated handleability by agreement with statements related to material properties, knotting, durability, approximation, efficiency, and willingness-to-use (1 (strongly disagree), 2 (disagree), 3 (neutral), 4 (agree), 5 (strongly agree)). Statistical analysis was performed using an unpaired t-test with Welch's correction

Results : PCL/DSP sutures were 29.2±0.6 µm in diameter and had a breaking strength of 0.5±0.03 N (mean±SD, n=10), meeting United States Pharmacopeia requirements for a synthetic, absorbable, 10-0 suture. Handleability ratings are shown in Table 1 with statistical analysis in Table 2. PCL/DSP sutures were rated between 4 and 5 on all metrics except knot burying. There was no significant difference in willingness-to-use between PCL/DSP (4.7±0.6) and nylon (5.0±0.0). Nylon rated significantly higher than PCL/DSP in glideability and knot burying (p<0.05) and Vicryl in memory (p<0.01), and glideability and willingness-to-use (p<0.05).

Conclusions : Nanofiber-based PCL/DSP sutures met 10-0 suture requirements and had comparable willingness-to-use to gold standard nylon sutures, demonstrating potential clinical utility as an anti-inflammatory suture for ocular trauma repair

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1. Evaluation of suture handleability (Mean ± SD, n=14).

 

Table 2. Statistical analysis of handleability results
P > 0.05 not significant (ns), P ≤ 0.05 *, P ≤ 0.01 **