Wound Integrity of Clear Corneal Incisions Closed with Fibrin and N-Butyl-2-Cyanoacrylate Adhesives

Purpose: To compare the integrity of clear corneal incisions closed with fibrin (Tisseel(R)) and n-butyl-2-cyanoacrylate (Histoacryl(R)) tissue adhesives to those closed with conventional sutures. Methods: Four replicate experiments were performed on porcine eyes with each of the following conditions: three limbal clear corneal incision sizes (3.0 mm, 4.5 mm, and 6.0 mm), three incision closure techniques (fibrin adhesive, n-butyl-2-cyanoacrylate adhesive, and 10-0 interrupted nylon sutures)1, 2, and 3 sutures at the 3.0-mm, 4.5-mm, and 6.0-mm incision sizes, respectively. Wound integrity was then measured by elevating the intraocular pressure of the eye to the point where wound leakage (IOPL) occurred. Two-way repeated measures analysis of variance (ANOVA) was used to analyze the IOPL data. Results: Incision closure technique and incision size showed significant interaction in the ANOVA model (p = 0.0008). Fibrin adhesive demonstrated higher IOPL compared to suture closure at the 3.0-mm incision size (p < 0.0001). There was no significant difference in IOPL when comparing wound closure with fibrin adhesive and sutures at the 4.5-mm and 6.0-mm incision sizes (p = 0.52 and p = 0.56, respectively). There was no significant difference between the three closure techniques for the 6.0-mm incisions (p > 0.15). When comparing the wound closure techniques for all incision sizes, the mean IOPL significantly increased in the following order: suture(s), fibrin adhesive, n-butyl-2-cyanoacrylate glue. Conclusions: Fibrin or n-butyl-2-cyanoacrylate tissue adhesive may be used as a more stable alternative to conventional sutures in the closure of clear corneal incisions.