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

Darakshan A, Amitava AK - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: Gluing took significantly longer by 5.24+/-1.91 min (95% CI for difference: 3.87-6.61).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.

View Article: PubMed Central - PubMed

Affiliation: Institute of Ophthalmology, JN Medical College, Aligarh Muslim University, Aligarh, UP, India.

ABSTRACT

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.

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Related in: MedlinePlus

Iso-amyl cyanoacrylate being applied to the edge of the disinserted muscle edge with a 25G needle
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Figure 0001: Iso-amyl cyanoacrylate being applied to the edge of the disinserted muscle edge with a 25G needle

Mentions: Surgery was performed under standard peribulbar block. Using 5-0 silk traction sutures at 12 and 6 o’clock, the muscle was approached by the limbal approach. Prior to disinsertion, we passed a 6-0 double-armed Vicryl suture as follows: first a bite through the central belly was taken and then a whip stitch passed on the two edges of the tendon, near the insertion. We noted the time at disinsertion in order to calculate the length of time for reattachment of the muscle. For the study (IAC) group, we dried both the muscle and the sclera with cellulose strips and marked the point of required recession on the sclera after measuring with calipers. After applying one drop of IAC to both the scleral site and the cut edge of the muscle with a 25-gauge cannula [Fig. 1], we held them in apposition for 45 sec [Fig. 2]. In case there appeared to be a good ‘take’ evident from a good adhesion, no peeling-off appearance of the edge of the muscle, and a global movement on gently tugging at the (pre-placed) 6-0 Vicryl suture, then time to completion of adhesion was noted (glue time: GT). In the event that the attachment failed, we planned to re-apply once more before switching to standard sutural recession surgery. The 6-0 Vicryl sutures were passed through the insertion stump as a backup option to be used as an adjustable hang-back suture, in the unlikely event of the bioadhesive giving way. The ends were left long and carefully attached (with micropore) to the forehead at the end of surgery, and were to be removed after 4-6 h, if not needed. In the eye constituting the control (PGS) group, we sutured the disinserted muscle to the sclera with the 6-0 Vicryl in a standard cross sword fashion. At the end, time to completion of suturing was noted (Vicryl time: VT). We reattached the conjunctiva at two points with Vicryl (8-0) suture. The eyes were patched for 4 to 6 h. A combination of ofloxacin (Oflacin, Microvision, India) with ketorolac (Ketoflox: Allergan, India) drops were applied four times a day for at least 15 days.


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

Darakshan A, Amitava AK - Indian J Ophthalmol (2010 Sep-Oct)

Iso-amyl cyanoacrylate being applied to the edge of the disinserted muscle edge with a 25G needle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992914&req=5

Figure 0001: Iso-amyl cyanoacrylate being applied to the edge of the disinserted muscle edge with a 25G needle
Mentions: Surgery was performed under standard peribulbar block. Using 5-0 silk traction sutures at 12 and 6 o’clock, the muscle was approached by the limbal approach. Prior to disinsertion, we passed a 6-0 double-armed Vicryl suture as follows: first a bite through the central belly was taken and then a whip stitch passed on the two edges of the tendon, near the insertion. We noted the time at disinsertion in order to calculate the length of time for reattachment of the muscle. For the study (IAC) group, we dried both the muscle and the sclera with cellulose strips and marked the point of required recession on the sclera after measuring with calipers. After applying one drop of IAC to both the scleral site and the cut edge of the muscle with a 25-gauge cannula [Fig. 1], we held them in apposition for 45 sec [Fig. 2]. In case there appeared to be a good ‘take’ evident from a good adhesion, no peeling-off appearance of the edge of the muscle, and a global movement on gently tugging at the (pre-placed) 6-0 Vicryl suture, then time to completion of adhesion was noted (glue time: GT). In the event that the attachment failed, we planned to re-apply once more before switching to standard sutural recession surgery. The 6-0 Vicryl sutures were passed through the insertion stump as a backup option to be used as an adjustable hang-back suture, in the unlikely event of the bioadhesive giving way. The ends were left long and carefully attached (with micropore) to the forehead at the end of surgery, and were to be removed after 4-6 h, if not needed. In the eye constituting the control (PGS) group, we sutured the disinserted muscle to the sclera with the 6-0 Vicryl in a standard cross sword fashion. At the end, time to completion of suturing was noted (Vicryl time: VT). We reattached the conjunctiva at two points with Vicryl (8-0) suture. The eyes were patched for 4 to 6 h. A combination of ofloxacin (Oflacin, Microvision, India) with ketorolac (Ketoflox: Allergan, India) drops were applied four times a day for at least 15 days.

Bottom Line: Gluing took significantly longer by 5.24+/-1.91 min (95% CI for difference: 3.87-6.61).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.

View Article: PubMed Central - PubMed

Affiliation: Institute of Ophthalmology, JN Medical College, Aligarh Muslim University, Aligarh, UP, India.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus