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Jeffrey N. Bloom, MD; Mark T. Duffy, MD, PhD; Jason B. Davis, BS; Karen M. McNally-Heintzelman, PhD

Arch Ophthalmol. 2003;121:1591-1595.

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.

From the Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago (Drs Bloom and Duffy); and Department of Applied Biology and Biomedical Engineering, Rose-Hulman Institute of Technology, Terre Haute, Ind (Dr McNally-Heintzelman and Mr Davis). The authors have no relevant financial interest in this article.

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