2-Octyl cyanoacrylate tissue adhesive and muscle attachment to porous anophthalmic orbital implants

Purpose: To investigate the tolerance and efficacy of a topical bioadhesive for direct muscle attachment to porous orbital motility implants. Methods: Ten New Zealand White rabbits underwent unilateral enucleation with unwrapped 12-mm spherical porous implants placed into the muscle cone. Four animals received porous polyethylene implants and 6 received bone-derived hydroxyapatite implants. Small amounts of a bioadhesive (2-octyl cyanoacrylate) were applied to the underside of the muscles. Muscles were placed onto the desired location of the implant with pressure for 15 seconds. The conjunctiva was closed with a 6-0 plain gut suture, and the animals were observed for 6 weeks. At 6 weeks, animals were killed and the surgical orbit was exenterated. Orbits and implants were processed for histologic analysis. In addition, tensile strength testing of muscle-implant attachments was performed and compared with various other types of muscle-implant or muscle-sclera attachments. Results: All cases resulted in integration of the muscles without slippage. All unwrapped hydroxyapatite implants (n = 6/6) had small anterior implant exposures without infection, significant inflammation, or exposure. No exposures were noted in porous polyethylene implants (n = 0/4). All implants were filled with fibrovascular tissue by 6 weeks. 2-Octyl cyanoacrylate yielded tensile strengths similar to that of sutured muscle coupling. Conclusions: 2-Octyl cyanoacrylate is well tolerated in the orbit, inducing minimal inflammation. It effectively attaches muscles to porous implants without hindering permanent integration or vascularization. The exposure rate for unwrapped hydroxyapatite spheres was not caused by the adhesive, as evidenced by the lack of exposures in the porous polyethylene implant group. 2-Octyl cyanoacrylate may be effective in reducing the cost and time for enucleation surgeries when porous motility implants are used.