First Author: P.Koay UK
Co Author(s): R. Peden
Purpose:
The clinical use of cyanoacrylate glue in the repair of corneal melt and corneal perforation is critical in preserving the integrity of the globe of the eye and preserving vision. To the best of our knowledge there has been no description in the literature of a reliable method of accurately controlling drop size. The purpose of this study is to describe and evaluate a technique for controlling cyanoacrylate glue drop size using a suture-brush construct.
Setting:
This is an in vitro study conducted in the operating theatres of St Johns Hospital, which is part of NHS Lothians University Hospitals Division, NHS Scotland, UK.
Methods:
The following suture materials were used, in a range of diameters:
1. Coated VicrylTM polyglactin 910 sutures by Ethicon.
2. Polyamide monofilament (EthilonTM) sutures by Ethicon.
3. Braided silk sutures (MersilkTM by Ethicon and SofsilkTM by Syneture).
4. Coated, braided polyester (Ti.cronTM) sutures by Syneture.
The needles were removed with a perpendicular cut from a standard suture cutter (Swann Morton LTD. Sheffield, England).
The sutures were submerged in N-butyl-2-cyanoacrylate (Histoacryl®, B.Braun, Aesculap AG. Tuttlingen, Germany) to a length of 5mm for 3 seconds, and removed vertically. They were touched to the measuring surface (1mm squared ECG paper coated with a transparent film dressing (TegadermTM, 3M Health Care, Germany) to simulate a dry, non-absorbant corneal surface) using a touch and off technique. This was repeated 10 times for each suture diameter.
Drops were applied and allowed to dry at an ambient temperature of 21oC. The resultant long and short diameters were measured using magnified digital photography. The surface areas of the drops were calculated using the formula (A = surface area, R1 = long radius, R2 = short radius: the drops were considered to be approximately elliptical).
Statistical analysis was conducted using Microsoft Excel® Version 11 (Microsoft Corporation, USA).
Results:
Coated VicrylTM polyglactin 910
Suture Diameter (?) Mean surface area (?2) Standard Deviation (?2)
40 1,487,400 350,816
35 1,246,000 372,747
30 1,156,800 164,348
20 585,444 170,571
15 502,600 166,812
10 260,000 28,274
Differences in mean surface area (MSA) produced using VicrylTM statistically significant (p<0.05) except between 35? and 30? (p= 0.4757) and between 20? and 15? (p= 0.1708).
Polyamide monofilament (EthilonTM)
Suture Diameter (?) Mean surface area (?2) Standard Deviation (?2)
40 802,714 350,048
30 421,000 76,813
20 285,571 95,744
10 66,333 48,198
Differences in MSA produced using EthilonTM statistically significant (p<0.05) except between 30? and 20? (p= 0.0799).
Braided silk (MersilkTM and SofsilkTM)
Suture Diameter (?) Mean surface area (?2) Standard Deviation (?2)
40 1,554,556 422,913
35 1,021,111 184,933
30 703,889 122,543
20 348,571 183,508
15 220,500 45,962
10 186,500 60,104
Differences in MSA produced using braided silk statistically significant (p<0.05) except those involving 15? and 10? (did not reliably produce drops).
Coated, braided polyester (Ti.cronTM)
Suture Diameter (?) Mean surface area (?2) Standard Deviation (?2)
30 706,200 143,957
20 506,875 132,119
15 293,333 60,291
Differences in MSA produced using Ti.cronTM were statistically significant (p<0.05).
Differences in MSA were tested for statistical significance using a 2-tailed paired T test.
Conclusions:
By varying the suture diameter used to form the applicator it is possible to vary the drop size of cyanoacrylate with a high degree of statistical significance.
Variation of drop diameter was noted between suture materials, with VicrylTM producing the largest drops (with the exception of 40? diameter, where it was similar to braided silk) and EthilonTM producing the smallest drops (likely due to a lack of wick action in the monofilament). The difference was statistically significant for all diameters of VicrylTM and EthilonTM (p<0.05 in 2-tailed paired T tests). Braided silk and braided polyester produced similar drop sizes that were not statistically different. VicrylTM and EthilonTM produced drop sizes that were different from braided silk and braided polyester (p<0.05) with the exception of 40? and 20? diameters.
The largest individual drop produced was 2,232,000?2 (using braided silk). This demonstrates that the technique described can be used to prevent excessive application of cyanoacrylate, which can cause foreign body sensation, acute inflammatory reactions and histopathological fibrosis in direct proportion to the amount of cyanoacrylate applied.
The application process described is quick and easy to perform, and involves only inexpensive, sterile equipment that is readily available in the operating theatre. FINANCIAL DISCLOSURE?: No
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