A light-activated surgical adhesive technique for sutureless ophthalmic surgery.

OBJECTIVE: To investigate a scaffold-enhanced, light-activated bioadhesive technique as a substitute for sutures in ophthalmic surgery. CLINICAL RELEVANCE: Suture use in ophthalmic surgery is technically demanding and time consuming and may be associated with serious complications such as inadvertent ocular penetration, which can result in retinal detachment and endophthalmitis. Bioadhesive surgery could eliminate many complications and limitations associated with the use of sutures. METHODS: The bioadhesive was composed of a poly(L-lactic-co-glycolic acid) (PLGA) porous scaffold doped with a protein solder mix composed of serum albumin and indocyanine green, which was activated with a diode laser. Extraocular rectus muscle-to-extraocular rectus muscle, sclera-to-sclera, and extraocular rectus 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% wt/vol bovine serum albumin and 0.5 mg/mL of indocyanine green saturated into a PLGA porous scaffold and activated with an 808-nm diode laser. The tensile strength was 81% of the native muscle's tensile strength (mean +/- SD, 433 +/- 70 g vs 494 +/- 73 g). Sclera-to-sclera adhesions achieved a mean +/- SD tensile strength of 295 +/- 38 g, whereas that for extraocular rectus muscle-to-sclera adhesions was 309 +/- 37 g. CONCLUSION: Sutureless surgery using this bioadhesive technique for various ophthalmic procedures appears feasible and may result in reduced surgical complications and cost.

Optimization of laser-solder repair technique for possible application in strabismus surgeries.

Strabismus is the lack of binocular vision due to an inability to control one of the eye muscles. Corrective surgery is the most common recourse and consists of adjusting and reattaching the extraocular muscle to the sclera. In approximately 10% of cases involving re-insertment of the extraocular muscle via suture techniques, the needle is inserted too deeply into the eye resulting in perforation of the retina. Fibrin glues and cyanoacrylates have been substituted with unsatisfactory mechanical results. The goal of this study was to maximize the tensile strength of rabbit extraocular muscles repaired using a laser-solder technique developed by McNally et al., Biodegradable polymer membranes of controlled porosity were fabricated with poly(L-lactic-co-glycolic acid) (PLGA) and salt particles using a solvent-casting and particulate-leaching technique. The porous membranes were doped with protein solder composed of 25% and 50% (w/v) serum albumin and 0.5 mg/ml indocyanine green (ICG) dye mixed in deionized water. In vitro tissue specimens were repaired using the solder-doped polymer membranes in conjunction with an 805 nm diode laser. The tensile strength was tested on an MTS machine and results were analyzed with the Student's T-test.