Adal-1 bioadhesive for sutureless recession muscle surgery: a clinical trial.

AIMS: To evaluate the efficacy and biotolerance of the Adal-1 adhesive for muscle sealing in strabismus surgery. METHODS: 27 eyes were included in the study: 17 in the control group and 10 in the study group. Surgery was performed on the recession of the horizontal rectus muscles. In the control group the muscle was joined to the sclera by a Vicryl 7/0 suture. In the study group, the Adal-1 adhesive was used instead. The efficacy of the sealing of the muscle to the sclera and the biotolerance of the surrounding tissues were evaluated. RESULTS: The muscular recession in the control group was 8.17 (SD 2.38) with displacement of the sealing point of 0.02 (1.7) mm. In the group sealed with adhesive, the muscular recession was 9.09 (3.08) and the displacement was 0.15 (1.56) mm, with no significant differences between the techniques (p<0.05). The inflammation of the surrounding tissues in the immediate postoperative period was greater with the suture technique (p>0.05), but there were no differences in the other postoperative periods (Mann-Whitney U test). CONCLUSION: Adal-1 was an effective and safe alternative to sutures in muscle recession for strabismus surgery in this study.

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure.

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.

Effect of topical antioxidant therapy on experimental infectious keratitis.

To test the effect that the treatment with topical antioxidants may have on corneal infection, we have studied the effect of topically applied antioxidants, such as dimethylthiourea 0.5% (DMTU) and dismutase superoxide 0.2% (SOD), on infectious experimental keratitis caused by Staphylococcus aureus. We have quantified the results of the incubated corneas in ex vivo as well as in in vivo treated with antioxidants by using the luminol amplified chemiluminescence technique (LAC). The evaluation of corneal inflammation was performed calculating the average inflammatory index obtained from the clinical observation of the corneal secretion, corneal edema and ciliary injection. The evolution of the corneal infiltration was evaluated by means of computerized planymetry. The antioxidants used in this study demonstrated a significant reduction of the LAC values when compared with a control group both in the in vivo as well as in ex vivo studies. No significant differences in the clinical evaluation of the average inflammatory index were observed between the study and the control groups. However, a significant increase in the corneal infiltration was registered in the antioxidant treated group (p < 0.001) evaluated by computerized planymetry. Our results indicate that the use of antioxidants as antiinflammatory drugs may have a potential negative influence on the course of infectious keratitis.

Use of cyanoacrylate tissue adhesive in small-incision cataract surgery.

BACKGROUND AND OBJECTIVE: A controlled clinical study was performed on three different groups of patients. PATIENTS AND METHODS: Each patient had a 6.5 mm-wide scleral tunnel with phacoemulsification. Sealing of the incision was done either without suture, with an anchor suture, or with tissue adhesive (cyanoacrylate). The authors observed whatever induced astigmatism was present during the 1st and 12th weeks of the postoperative period. RESULTS: In the immediate postoperative period, astigmatism was significantly less (P < .01) in the groups of patients with suture and tissue adhesive than in the unsutured group. The results after 12 weeks were similar for the three groups (P > .05), with no complications observed as a result of the use of cyanoacrylate. CONCLUSION: Cyanoacrylate seems to be a promising innovation in scleral tunnel surgery for cataracts. It is an effective, a quick, and a safe alternative to sutures.

Topical treatment of experimental acute corneal inflammation by dexamethasone and nonsteroidal drugs.

In this study, we have correlated the relative effectiveness of nonsteroidal anti-inflammatory drugs versus corticosteroids in the topical treatment of acute corneal inflammation. The authors have studied the effect of 1 drop every 6 h of flurbiprofen 0.03%, indomethacin 1%, diclofenac 0.1% and dexamethasone 0.1% in an experimental model of corneal alkali burn. The objective parameters used to evaluate the corneal inflammatory response were Luminol-enhanced chemiluminescence, ultrasonic pachymetry and computer-assisted analysis of the area of the corneal ulceration. Indomethacin 1% showed statistically significant effects on the improvement of all the parameters tested in the study. No such effect was demonstrated for flurbiprofen 0.03% or diclofenac 0.1%. We can conclude that indomethacin 1% is an effective drug in the treatment of experimental acute corneal alkali-burn inflammation.

Antioxidant therapy in the treatment of experimental acute corneal inflammation.

To ascertain the effectiveness of topical antioxidant therapy on acute corneal inflammation, we have studied the effectiveness of topical treatment with a saline solution and with antioxidants such as 0.2% superoxide dismutase and 0.5% dimethylthiourea (DMTU) in a controlled experimental study. The evolution of the inflammatory process was evaluated by a multimodel approach, including computer-assisted planimetry of the corneal ulcer and infiltrate, ultrasonic pachymetry, luminol-amplified chemiluminescence and the study of corneal transparency by direct spectral spectrophotometry transmittance. The experimental model was a corneal ulcer created by a 60-second application of 1 N sodium hydroxide. Topical treatment with DMTU was shown to significantly improve all parameters tested, while superoxide dismutase reduced only the corneal ulcers. Antioxidant topical therapy with DMTU was shown to be efficient in reducing the inflammatory reaction that occurs during acute corneal inflammation. This suggests that antioxidant therapy could be considered as a complementary treatment in the pharmacological modulation of acute corneal inflammation.