Octyl 2-cyanoacrylate in sutureless surgery of extraocular muscles: an experimental study in the rabbit model

Comparative evaluation of cyanoacrylate and fibrin glue for muscle recession in strabismus surgery

PURPOSE

To compare the safety and efficacy of fibrin glue and cyanoacrylate glue for refixating the recessed muscle to the sclera in patients undergoing strabismus surgery.

METHODS

In this prospective, randomized, and interventional case series, there were 15 patients in each group. Two different types of glue were used for refixating the muscle to the sclera after its recession: fibrin glue (fibrin group) and cyanoacrylate glue (cyanoacrylate group). Resection was performed as usual with a 6-0 polyglactin suture. The conjunctiva was closed with the same glue that was used for muscle recession.

RESULTS

Average time required per muscle attachment was 1.48±0.694 minutes in the fibrin group and 2.42±0.584 minutes in the cyanoacrylate group. There was no significant difference in pain at all postoperative visits in both groups. Significantly more chemosis was observed in the cyanoacrylate group at postoperative 3 weeks. At all other postoperative visits, there was no significant difference in chemosis in both groups. There was significantly more conjunctival reaction in the cyanoacrylate group at 1 and 3 weeks and 3 months; the difference was highly significant at 3 months (P=.00). Total inflammatory score was significantly high in the cyanoacrylate group at 1 week, 3 weeks, and 3 months.

CONCLUSIONS

Both fibrin and cyanoacrylate glue are equally efficacious for muscle reattachment; however, fibrin glue is more biotolerant compared to cyanoacrylate glue and results in less postoperative inflammation, and is thus recommended for recession in strabismus surgery.

Cyanoacrylate tissue adhesive on a polyglactin scaffold in strabismus surgery: a laboratory study

BACKGROUND

The use of cyanoacrylate tissue adhesives in strabismus surgery has been variously successful, depending primarily on achieving adequate bond strength and minimizing extraocular muscle slippage. We investigate a novel approach to this problem, involving cyanoacrylate tissue adhesive on a polyglactin 910 scaffold as a means to secure extraocular muscle to the sclera for strabismus surgery.

METHODS

In this experimental laboratory study, butyl-cyanoacrylate was used to fix a polyglactin 910 scaffold to the sclera of cadaver eyes. After allowing for polymerization, a force was applied to the mesh until the polyglactin-sclera bond failed. The maximum load (g) required for bond failure was recorded. The effects of surface area of the polyglactin 910 mesh as well as time required for cyanoacrylate tissue adhesive polymerization on bond strength were investigated.

RESULTS

All combination of variables tested, except for experiments involving polyglactin 910 mesh that is 30 mm(2) with a polymerization time of 15 seconds or 30 seconds and polyglactin 910 mesh that is 40 mm(2) with a polymerization time of 15 seconds, achieved a bond strength that was significantly greater than those forces seen in a physiologic setting (P > 0.05). Increasing area or time resulted in increasing bond strength. Area and time were found to be independent variables.

CONCLUSIONS

The cyanoacrylate tissue adhesive-derived polyglactin-sclera bond achieved a maximum load greater than those seen in a physiologic setting. Our novel approach demonstrates a clinically feasible alternative to traditional means for bonding muscle to sclera in strabismus surgery.

Cut and paste: a novel method of re-attaching rectus muscles with cyanoacrylate during recessions in strabismus

Aim:

Bio-adhesives like cyanoacrylate offer an alternative to sutures to attach tissues, including in ophthalmology. This prospective trial evaluated the suitability and bio-tolerance of iso-amyl cyanoacrylate in rectus muscle recession surgery for strabismus.

Materials and Methods:

We randomized one eye in each of 10 cases of bilateral horizontal rectus recessions to 6/0 polyglactin and the other to iso-amyl-cyanoacrylate. We compared time to reattachment (from disinsertion), complications and inflammatory scores (0 to +3: nil, mild, moderate and severe) on Day One, at two and at four to six weeks post surgery.

Results:

There were no significant group differences in inflammatory scores (Wilcoxon, all values of P>0.05). All attachments held firm. Gluing took significantly longer by 5.24±1.91 min (95% CI for difference: 3.87-6.61). There were no complications.

Conclusion:

We feel that although it takes marginally longer, iso-amyl cyanoacrylate offers an effective and safe alternative to sutures for muscle recession in strabismus surgery. Since it is cheaper (vs. polyglactin) and offers multi-use possibility it may also prove to be cost-effective.

Extraocular muscle fixation to porous polyethylene orbital implants using 2-octyl-cyanoacrylate

PURPOSE

To evaluate the efficacy of bioadhesive in attaching the extraocular muscles to porous polyethylene spheres in rabbit enucleated cavities.

METHODS

A prospective, experimental study was performed. Eight adult New Zealand white rabbits underwent right enucleation with insertion of an unwrapped 12 mm porous polyethylene sphere. The superior and inferior rectus muscles were attached to the implant with 2-octyl cyanoacrylate placed to the underside of the muscles and application of pressure for 5 seconds. Ninety days after surgery, the orbits were exenterated and four animals underwent histologic evaluation and the other four animals tensile strength testing of the muscle-sphere attachment.

RESULTS

There were no exposures or infections of the implants and the muscles remained attached in all cases. Histologic examination showed fibrous tissue reaction at the muscle-sphere attachment with minimal inflammation of the surrounding tissues; a pseudocapsule formation around the spheres and full vascularization of the implant was also observed. There was no evidence of residual glue on histologic examination. Tensile strength testing showed that rupture force was similar between bonded muscle and the porous polyethylene sphere.

CONCLUSIONS

The 2-octyl-cyanoacrylate did not cause deleterious effects in orbital tissues and provided strong adhesion between muscles and spheres. Bioadhesive may be an option for attaching the extraocular muscles to orbital implants in anophthalmic cavity reconstruction.

Cyanoacrylate adhesive use in primary operation and reoperation in rabbit eye muscle surgery

PURPOSE

To compare the performance of 2-octyl-cyanoacrylate to 6-0 polyglactin 910 suture in rabbit superior rectus muscle surgery after operation and reoperation procedures.

METHODS

A prospective noninferiority trial was conducted in rabbits. Bilateral superior rectus muscle recessions were performed using cyanoacrylate in one eye and polyglactin suture in the other. At 5 weeks, reoperations to advance the superior rectus muscle were performed on 20 rabbits. Slippage, tensile strength, ease of reoperation, operative time, and inflammatory reaction were recorded. For the primary outcomes, the predetermined margin of noninferiority was 1 mm for slippage and 100 g for tensile strength.

RESULTS

In both groups, the proportion of slippage > or =1 mm from the recession site was 1.9%. For the reoperation, it was 36.8% and 15.7% in the suture and cyanoacrylate groups, respectively, and the mean slippage was 0.60 mm and 0.42 mm. Mean tensile strength was 842.8 g for suture and 777.2 g for cyanoacrylate after the first operation and 877.73 g and 844.87 g after the reoperation. There was no difference between groups for surgical difficulty or inflammatory index. For the first operation, surgery using cyanoacrylate was on average 3.85 min faster than suture.

CONCLUSIONS

Cyanoacrylate can achieve an adequate muscle-sclera bond in the immediate period after surgery to avoid major slippage and does not affect the long-term process of wound healing for both recession and advancement procedures. It is well tolerated and does not add technical difficulty even if used for reoperations. Because it eliminates the risk of globe perforation, cyanoacrylate may be a good alternative to sutures in strabismus surgery.

Enhancing the strength of the tendon-suture interface using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride and cyanoacrylate

PURPOSE

Preventing gap or rupture is important to achieving a successful outcome after tendon repair. Weak sutures break; strong sutures fail by pull-out at the tendon-suture interface. In this study, we investigated the use of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) and cyanoacrylate to enhance the strength of the tendon-suture interface.

METHODS

Twenty-four canine flexor digitorum profundus tendons were used to test EDC and cyanoacrylate reinforcement methods, with 12 tendons in each group. A single-loop suture technique was used to test the tendon-suture interface strength.

RESULTS

The mean ultimate strengths of the EDC group and the cyanoacrylate group were significantly higher than those of their respective control groups. The stiffness of the group with cyanoacrylate-augmented loops was significantly higher than that of its respective control group. There was no significant difference in stiffness between the 2 reinforcement methods.

CONCLUSIONS

Our results suggest that tendon-suture interface reinforcement may improve the pull-out failure strength of a suture construct and thereby increase the effectiveness of stronger suture materials. Future studies might address the effects of different kinds and methods of reinforcement with various suture materials and constructs and in different tissues.

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.

Sutureless ophthalmic surgery: a scaffold-enhanced bioadhesive technique

PURPOSE

Bioadhesives have had limited use in ophthalmic surgery. Problems with these adhesives have included inadequate tensile strength and difficulty with their application to the tissue site. We evaluated a scaffold-enhanced cyanoacrylate bioadhesive composite as an alternative to sutures in ophthalmic surgery, including strabismus procedures.

METHODS AND MATERIALS

The bioadhesive composite consisted of 2-octyl-cyanoacrylate combined with either a poly(L-lactic-co-glycolic acid) (PLGA) scaffold or a rehydrated porcine small intestine submucosa (SIS) scaffold. Extraocular rectus muscle and sclera were obtained from rabbits (n = 40) and were used, with these bioadhesive composites, to produce rectus muscle-to-sclera, sclera-to-sclera, and rectus muscle-to-rectus muscle adhesions. Control adhesions were created with cyanoacrylate only. The breaking load of the tissue repair was measured with a material strength-testing machine.

RESULTS

In all cases, the scaffold-enhanced cyanoacrylate adhesions were significantly stronger (P < 0.001) than the cyanoacrylate alone. The rectus muscle-to-sclera adhesions were greater than the in vivo forces reported for the horizontal rectus muscles in humans in extreme gaze.

CONCLUSION

This scaffold-enhanced bioadhesive composite produced initial muscle-sclera adhesions with strength satisfactory for strabismus surgery. It also may be applicable to other categories of ophthalmic surgery as a substitute for sutures.

Octyl 2-cyanoacrylate tissue adhesive in experimental scleral buckling

PURPOSE

In this experimental study, a sutureless scleral buckling was performed by using a tissue adhesive glue to fixate a silicone band to the sclera. In fact, one of the major risks of traditional scleral buckling is accidental perforation of the bulb, which is more frequent when the sclera is extremely thin as it is in newborns or in eyes with high myopia or scleromalacia.

METHODS

An encircling band of silicone, which is generally anchored to the sclera itself, was sutured in 36 rabbit eyes to three small silastic patches that had been glued to the sclera, at the level of the equator, using octyl 2-cyanoacrylate tissue adhesive. In this manner the anchoring sutures passed through silicone and silicone. The band was tightened to produce buckling of the sclera and its ends were glued together using the same adhesive.

RESULTS

Examination of the eyes from 15 days to 6 months after surgery revealed that the buckle was stable, with no signs of slippage, in 33 eyes. In the remaining 3 (one examined after 15 days, 2 examined after 45 days), one of the three support patches had become detached but there was still no evidence of slippage.

CONCLUSIONS

The stability of the buckle up to six months after surgery suggests that this new adhesive might be used for sutureless surgery in certain types of retinal detachment, such as that associated with stage 4 ROP in which the encircling band has to be removed after several months.