Research ArticleBIOMATERIALS

A reversible thermoresponsive sealant for temporary closure of ocular trauma

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Science Translational Medicine  06 Dec 2017:
Vol. 9, Issue 419, eaan3879
DOI: 10.1126/scitranslmed.aan3879

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A sealant to save sight

Traumatic eye injuries require rapid treatment to prevent deterioration of vision. As an alternative to suturing or adhesives, Bayat and colleagues developed a temperature-responsive synthetic hydrogel that acts as a temporary sealant. Testing the hydrogel in a model of open globe injury in rabbits showed that the sealant was easily deployed from a custom-designed temperature-controlled syringe device and preserved intraocular pressure without evidence of chronic inflammation or toxicity. After gelation, the sealant could be removed by exposure to cold water. In combat or low-resource settings, this hydrogel could close wounds temporarily to prevent further tissue damage or vision loss before surgery.

Abstract

Open globe injuries are full-thickness injuries sustained to the eye wall (cornea or sclera), which cause immediate drops in intraocular pressure that may lead to retinal detachment and permanent vision loss if not treated rapidly after injury. The current standard of care for open globe injuries consists of suturing the margins closed, but the technique can be time-consuming, requires specialized training and equipment, and can lead to patient discomfort, abrasion, and infection from eye rubbing. We engineered an injectable, thermoresponsive sealant (TRS) and a custom tool to occlude open globe injuries. The smart hydrogel sealant consists of physically cross-linked N-isopropylacrylamide copolymerized with butylacrylate. At low temperatures, it can be injected as a liquid, and when raised to body temperature, a heat-induced gelation converts the hydrogel into a solidified occlusion. The sealant can be repositioned or removed without causing additional trauma via exposure to cold water. In vitro and ex vivo assessments of mechanical adhesion to eye tissue revealed maintenance of intraocular pressure that is five times greater than the physiological range with reversible seal strength comparable to cyanoacrylate (super glue). In vivo assessment in a rabbit model of ocular trauma demonstrated ease of use for TRS deployment, statistically significant improvement in wound sealing, and no evidence of neurotoxicity, retinal tissue degradation, or significant chronic inflammatory response after 30 days of exposure. Given the advantages of body heat–induced gelation, rapid reversible occlusion, and in vivo safety and efficacy, shape-adaptable TRSs have translational potential as smart wound sealants for temporary occlusion of surgical incisions or traumatic injuries.

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