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New Dendritic Adhesives for Sutureless Ophthalmic Surgical Procedures
In Vitro Studies of Corneal Laceration Repair
Andrew J. Velazquez, MD;
Michael A. Carnahan;
Johannes Kristinsson, MD, PhD;
Sandra Stinnett, DrPH;
Mark W. Grinstaff, PhD;
Terry Kim, MD
Arch Ophthalmol. 2004;122:867-870.
Objective To compare a biodendrimer adhesive with a conventional suture for repairing linear and stellate corneal lacerations.
Methods A keratome knife was used to create 4.1-mm full-thickness linear incisions (n = 36) and 3 x 4-mm full-thickness stellate incisions (n = 25) in the central cornea of enucleated human eyes. The incisions were sealed with either a suture or the biodendrimer adhesive. The globes were inflated with balanced salt solution, and the increase in intraocular pressure was monitored via a cardiac transducer until fluid leaked from each eye. This intraocular pressure reading from the transducer was recorded at the sight of any leakage through the wound (leakage pressure). By using the Wilcoxon rank sum test, the median leakage pressure was compared for each closure method, separately for each wound group. By using the 1-sided 1-sample t test, each mean leakage pressure value was compared with 34 mm Hg, which is the intraocular pressure under certain stressful physiologic conditions (eg, coughing and the Valsalva maneuver).
Results For globes that underwent a linear incision, the mean leakage pressure was 78.7 mm Hg for the sutured group and 109.6 mm Hg for the adhesive group. Globes that underwent a stellate incision had a mean leakage pressure of 57.8 mm Hg for the sutured group and 78.7 mm Hg for the adhesive group. All of these pressures showed a statistical significance from 34 mm Hg via a 1-sided 1-sample t test.
Conclusions The difference in leakage pressures for all 4 groups was statistically significant relative to 34 mm Hg. This suggests that either method of closure, adhesive or suture, can withstand physiologic increases in intraocular pressure postoperatively and that biodendrimer adhesives are able to seal large corneal lacerations.
Clinical Relevance The use of biodendrimer adhesives to repair a corneal wound constitutes a viable alternative clinical procedure to conventional sutures.
From the Departments of Ophthalmology (Drs Velazquez, Kristinsson, Stinnett, Grinstaff, and Kim) and Chemistry (Mr Carnahan), Duke University, Durham, NC. Dr Grinstaff is now with the Department of Biomedical Engineering and Chemistry, Boston University, Boston, Mass. The authors have no relevant financial interest in this article.
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