Abstract
Purpose Corneal perforation is a clinical emergency. Tissue glue to seal the perforation, and supplementary topical medication represents existing standard treatment. Previously, our group developed a transparent bioink that showed good cell compatibility and accelerated corneal epithelial cells healing in-vitro. This study aims to develop a novel treatment method for corneal perforation using this bioink.
Methods Rheometry was used to measure bioink behaviour at room and corneal surface temperatures. Bioink adhesiveness to porcine skin and burst pressure limit were also measured. Based on rheological behaviour, a hand-held biopen was developed to extrude the bioink onto the cornea. An animal trial (5 New Zealand white rabbits) to compare bioink and cyanoacrylate glue (control group) impact on a 2mm perforation was conducted to evaluate safety and efficacy.
Results Bioink has higher adhesiveness compared to commercial fibrin glue and can withstand burst pressure approximately 6.4x higher than routine intraocular pressure. Bioink-treated rabbits had lower pain score and faster recovery, despite generating similar scar-forming structure after healing compared to controls. No secondary corneal ulcer was generated in rabbits treated with bioink.
Conclusions This study reports a novel in-situ printing system capable of delivering a transparent bioink to the cornea and successfully treating small corneal perforations. Bioink-treated rabbits recovered faster to completely healed perforation and required no additional analgesia. Both groups showed scarred corneal tissue after healing, however no infection and inflammation was observed 3 weeks. The delivery system was easy to use and may represent an alternative treatment for corneal perforation.
Highlights
This study presents a novel in situ printing system to treat corneal perforation
The system is comprised of a human platelet lysate-based bioink and a pen-like hand held delivery system
Mechanical tests showed our transparent bioink has a higher adhesiveness compared to existing treatments and burst pressure threshold approximately 6.4 times higher than normal intraocular pressure.
In vivo rabbit trial showed that compared to cyanoacrylate glue, the bioink was safer, faster healing and led to less pain in rabbits.
Competing Interest Statement
J. You (P), iFix Medical (I,F); H. Frazer (P); S. Sayyar, None; Z. Chen, None; X. Liu, None; A. Taylor, None; B. Filippi, None; S. Beirne, None; I. Wise, None; C. Hodge, None; G. Wallace, None; G. Sutton (P), iFix Medical (I). P: Patent, I: Personal Financial Interest; F: Financial support