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

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.

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

“…We are grateful for the interest shown by the authors in our article,[12] and the issues raised by them.…”

Stiffened hang-back: A suggested modification using cyanoacrylate glue

“…Studies have shown that the muscle-sclera bond achieved using cyanoacrylate can withstand loads far more than the maximum force of 75 g generated by the human extra-ocular muscles. [ 3 4 ] Cyanoacrylates need minimal hydration to polymerize. The tensile strength of the bond is highest of all glues.…”

Isoamylcyanoacrylate for sutureless horizontal rectus recession surgery

“…We read the article by Darakshan et al . [ 1 ] with keen interest. We wish to make following observations to refine this article:…”

“…[ 2 – 4 ] Only few studies of cyanoacrylate in strabismus surgery in humans are on record. [ 1 5 6 ] We congratulate the authors for reporting cyanoacrylate in rectus muscle recession for strabismus in India. However, authors[ 1 ] missed to cite the article which was the first one to describe the use of cyanoacrylate in strabismus surgeries in 10 patients.…”

“…[ 1 5 6 ] We congratulate the authors for reporting cyanoacrylate in rectus muscle recession for strabismus in India. However, authors[ 1 ] missed to cite the article which was the first one to describe the use of cyanoacrylate in strabismus surgeries in 10 patients. [ 6 ] The authors have mentioned that one drop of isoamylcyanoacrylate (IAC) was applied to both the scleral site and the cut edge of the muscle and held them in apposition.…”