Development of Drug-Eluting, Absorbable Sutures for Ocular Trauma Surgery
Abstract
Objectives and Rationale: We propose to develop anti-inflammatory drug-eluting sutures as an alternative to conventional nylon sutures for use in surgeries for repairing military-relevant ocular injuries. Studies have shown that effective wound closure and prevention of infection are key to improved visual outcomes following injuries to the eye and surrounding tissues. This includes promoting rapid and complete wound repair with minimal scarring and other post-surgical complications. Typically, patients must administer eye drops multiple times per day after ocular injuries are surgically repaired. This regimen is difficult and time-consuming, and patients or caregivers often fail to give drops as instructed. Poor eye drop adherence can lead to poor visual outcomes following surgery. In addition, repeated eye drop administration leads to repeated spikes in drug concentrations that can cause undesirable side effects. In contrast, we propose to utilize sutures already used in surgical repair to deliver low, but effective, amounts of anti-inflammatory drugs in a sustained manner (over >30 days) directly to the wound. Thus, the suture would serve to both close the wound and to provide immediate therapeutic delivery directly to the surgical site to control the healing process and improve surgical outcomes. A drug-eluting suture would provide immediate and sustained delivery of an anti-inflammatory agent directly to the surgical site while also providing appropriate, long-term wound closure to prevent wound leaks and maintain the integrity of ocular tissues. To date, however, there are no market offerings for drug-eluting sutures for ocular surgery. It is challenging to make strong enough sutures, particularly of the thin size range required for ocular surgeries, using absorbable polymers that are loaded with drug. Sutures used in repair of ocular trauma can be thinner than a human hair and they must surpass the minimum tensile strength required for the surgeon to tie secure knots and for the sutures to remain intact during the healing process. In the literature to date, typical descriptions of absorbable, drug-eluting sutures report tensile strengths of less than 10% of what is required for use in patients. Here, we describe new engineering methods that allow us to produce sutures that are ultra-thin and high-strength while providing sustained release of drugs in the eye. To our knowledge, these are the first drug-loaded sutures that meet and surpass clinical tensile strength requirements. Military and Societal Benefit: Injuries to the eye and surrounding areas represent a large proportion of combat- and non-combat-related injuries in military Service members. The average military eye injury results in a loss of 5-6 days of work and costs $3K-$10K. In one study, injuries that include penetration of the eyeball, which are associated with the worst long-term visual outcomes, constituted 55% of combat ocular trauma injuries. Thus, new strategies for promoting healing and preservation of vision will be of great benefit to the military. Sutures are used in surgical procedures for ocular wound closure, followed by prescription of topical anti-inflammatory eye drops to control post-surgical inflammation and healing. We propose to combine wound closure and post-operative medications by developing sutures that deliver drugs over weeks to months. By loading sutures with anti-inflammatory drugs to deliver them in a sustained manner directly to the surgical site, scarring and other post-surgical complications can be minimized without the need for topical eye drops. This approach has significant implications for improved treatment and management of ocular injuries sustained by military Service people, Veterans, and civilians alike. Further, sutures are used in many other types of ocular surgeries, typically in conjunction with topical eye drops. Thus, drug-eluting sutures have broad applicability for use in the civilian population for corn
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010922
Entities
People
- Laura M Ensign
Organizations
- Johns Hopkins University
- United States Army