Proof-of-Concept Study of a Sutureless Glycerin-Preserved Corneal Plug for Perforation Repair: Cufflink Design, Eye Bank Processing, and Ex Vivo Burst Pressure Testing

Evan W. Balk; Simran R. Sarin; Aaron Dotson; Guadalupe Torres; Luke Grandgenett; Christopher S. Sales

doi:10.1097/coa.0000000000000067

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Proof-of-Concept Study of a Sutureless Glycerin-Preserved Corneal Plug for Perforation Repair: Cufflink Design, Eye Bank Processing, and Ex Vivo Burst Pressure Testing

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Proof-of-Concept Study of a Sutureless Glycerin-Preserved Corneal Plug for Perforation Repair: Cufflink Design, Eye Bank Processing, and Ex Vivo Burst Pressure Testing

Evan W. Balk, Simran R. Sarin, Aaron Dotson, Guadalupe Torres, Luke Grandgenett and Christopher S. Sales

Cornea Open, Vol.4(3), e0067

09/2025

DOI: 10.1097/coa.0000000000000067

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Abstract

Purpose: To develop and evaluate a sutureless, cufflink-shaped corneal plug for managing keratolytic corneal perforations and to establish an ex vivo perforation model for plug testing. Methods: We designed a cufflink-shaped corneal plug with 2 leaflets separated by an encircling groove. Plugs were made from 1-month glycerin-preserved donor corneas using either manual- or device-assisted techniques. Manually cut plugs were created using a crescent blade, micrometer, and recessed cutting well; device-cut plugs used a device that controlled groove depth and location. Simulated keratolytic perforations were made on ex vivo corneoscleral rims using a Dremel tool to create a wide erosion and a small initial perforation, followed by augmentation to a 1-mm full-thickness hole. Burst pressure testing compared plug strength in corneoscleral rims sealed with plugs and cyanoacrylate tissue adhesive on an artificial anterior chamber (n = 5 plugs per technique). Plug dimensions were analyzed using Fiji. Results: Device-cut plugs withstood higher burst pressures than manually cut plugs (465 ± 17 mm Hg vs. 385 ± 107 mm Hg). Device-cut plug dimensions were consistent; plug and leaflet thicknesses did not differ from the target (P = 0.06 and 0.53), although groove depth differed slightly (P = 0.02). Conclusions: Cufflink-shaped, glycerin-preserved corneal plugs cut with simple devices provide robust seals for corneal perforations because of incorporation of an internal leaflet. The use of shelf-stable material, a cutting device operable by nonsurgeons (ie, eye bank technicians), and the potential for in-clinic application make this a scalable approach.

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Title: Subtitle: Proof-of-Concept Study of a Sutureless Glycerin-Preserved Corneal Plug for Perforation Repair: Cufflink Design, Eye Bank Processing, and Ex Vivo Burst Pressure Testing
Creators: Evan W. Balk - University of Iowa
Simran R. Sarin - University of Iowa
Aaron Dotson - University of Iowa
Guadalupe Torres - Department of Ophthalmology and Visual Sciences, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
Luke Grandgenett - University of Iowa
Christopher S. Sales - University of Iowa
Resource Type: Journal article
Publication Details: Cornea Open, Vol.4(3), e0067
DOI: 10.1097/coa.0000000000000067
ISSN: 2833-6992
eISSN: 2833-6992
Language: English
Date published: 09/2025
Academic Unit: Stead Family Department of Pediatrics; Ophthalmology and Visual Sciences
Record Identifier: 9984969237302771

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