Cyanoacrylate tissue adhesive in the management of recurrent retinal detachment caused by macular hole.

Nine eyes of nine patients with rhegmatogenous retinal detachment caused by a macular hole were treated by the transvitreal application of cyanoacrylate tissue adhesive to the macular hole. Eight of the nine eyes had previously failed conventional vitreous surgery with gas tamponade and laser photocoagulation. Eight eyes (89%) were completely reattached with a minimum follow-up of three months. In the successfully treated eyes, post-operative visual acuity was 20/200 in two eyes, 20/400 to 5/200 in five eyes, and less than 5/200 in one eye. Direct sealing of macular holes in difficult cases may obviate the need for extended intraocular tamponade or macular buckling with their associated complications.

Retinal toxicity of cyanoacrylate tissue adhesive in the rabbit.

N-butyl-2-cyanoacrylate tissue adhesive was injected into the preretinal space of rabbit eyes to study potential toxicity to the retina. Application of 3.3-10.0 ul of cyanoacrylate tissue adhesive showed localized but definite retinal toxicity. White halos appeared surrounding the preretinal cyanoacrylate immediately after injection with a gradual evolution of the white areas into pigmentary scars by 1 month. Histological examination confirmed severe focal necrosis of the retina. No identifiable distant toxic effects or electrophysiologic changes were observed during the 6-month follow-up period.

Transvitreal cyanoacrylate retinopexy in the management of complicated retinal detachment.

We used transvitreally delivered cyanoacrylate tissue adhesive to seal retinal breaks in 25 selected patients undergoing vitreous surgery for complicated retinal detachment. With a minimum follow-up period of six months, all but one retinal hole remained closed. Complete retinal reattachment posterior to the encircling buckle was achieved in 18 of 25 eyes (72%). In ten of 25 eyes (40%) the final visual acuity was 5/200 or better.

Experimental transvitreal cyanoacrylate retinopexy in a primate model.

We evaluated the use of transvitreal cyanoacrylate retinopexy in the treatment of experimental rhegmatogenous retinal detachment during vitreous surgery in the cynomolgus monkey. The chorioretinal adhesions produced with cyanoacrylate tissue adhesive as compared with those produced by transscleral retinal cryopexy were more rapid in onset as well as stronger. To test the efficacy of cyanoacrylate retinopexy further, a 360-degree peripheral retinectomy was created in five eyes with circumferential cyanoacrylate application to the posterior retinal edge. The cyanoacrylate retinopexy did not prevent the development of proliferative vitreoretinopathy with traction retinal detachment, but in three of the eyes the tissue adhesive continued to maintain retinal apposition to the retinal pigment epithelium at the retinotomy edge. Histologic examination of the retinas disclosed a foreign body reaction adjacent to the cyanoacrylate sites, but there was no evidence of any distant effects caused by the tissue adhesive.

Classification of the stages of proliferative vitreoretinopathy in a refined experimental model in the rabbit eye.

Eighty-four rabbit eyes injected intravitreously with tissue-cultured fibroblasts following gas compression of the vitreous were examined clinically over a period of 1 month. Detailed clinical descriptions of the extent of retinal changes were recorded. Clinical landmarks were determined and arranged into a new classification of this model of proliferative vitreoretinopathy (PVR). The proposed classification will allow easier communication between research groups using this model to study the treatment and prevention of PVR.

Transvitreal cyanoacrylate retinopexy in the management of complicated retinal detachment.

Failures in vitreous surgery for complex vitreoretinal disorders are frequently due to an inability to keep preexisting or iatrogenic retinal breaks permanently closed. We have used transvitreally delivered cyanoacrylate tissue adhesive to seal retinal breaks in selected patients undergoing vitreous surgery for complicated retinal detachment. With a minimum follow-up period of 6 months, all but one retinal hole have remained closed and complete retinal reattachment posterior to the encircling buckle was achieved in 18 of 25 eyes (72%). In 10 of the 25 eyes (40%) the final visual acuity was 5/200 or better.

Experimental transvitreal cyanoacrylate retinopexy through silicone oil.

We evaluated the use of transvitreal cyanoacrylate retinopexy in the treatment of experimental rhegmatogenous retinal detachment during vitreous surgery in rabbit eyes filled with silicone oil. The view to the fundus was superior to that obtained in our previous model of cyanoacrylate retinopexy in the air-filled eye. Glue delivery was consequently both easier and more precise through silicone oil relative to air. The chorioretinal adhesions produced with cyanoacrylate tissue adhesive were compared with those produced by transscleral retinal cryopexy and were found to be more rapid in onset as well as stronger. An exaggerated tissue response adjacent to the cyanoacrylate site suggested a potential toxic chemical or thermal reaction, or both, to the tissue adhesive, but there was no evidence of any distant ocular effects.

Experimental transvitreal cyanoacrylate retinopexy.

We used an experimental rabbit model of rhegmatogenous retinal detachment to compare the onset, quality, and duration of chorioretinal adhesions obtained by transvitreal application of N-butyl-2-cyanoacrylate mixed with iophendylate with those obtained by transscleral retinal cryopexy. The chorioretinal adhesions produced by the cyanoacrylate tissue adhesive were immediate in onset, stronger, and long lasting.