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Biomechanical Considerations of Patching Material for Posterior Scleral Reinforcement Surgery
Jinlei Ma1, Fangyuan Wu1, Zhiyong Liu1
1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.
Frontiers in Medicine
|June 2, 2022
Summary
Genipin-crosslinked human dura mater shows superior biomechanical properties compared to sclera for posterior scleral reinforcement (PSR). This dura mater graft effectively reduced axial length and improved vision in high myopia patients over three years.
Area of Science:
- Biomaterials Science
- Ophthalmology
- Tissue Engineering
Background:
- Posterior scleral reinforcement (PSR) is a surgical technique to manage progressive high myopia.
- Biocompatible reinforcing materials are crucial for the efficacy and safety of PSR.
- Human dura mater and sclera are potential autograft or allograft materials for ocular tissue engineering.
Purpose of the Study:
- To characterize the biomechanical properties of genipin-crosslinked human dura mater.
- To compare genipin-crosslinked dura mater with genipin-crosslinked human sclera.
- To evaluate the efficacy and safety of crosslinked dura mater as a reinforcing material for PSR in patients with pathologic myopia.
Main Methods:
- Human dura mater and sclera were crosslinked using an optimized genipin solution.
- Enzyme degradation resistance was assessed through accelerated enzymatic exposure.
- Biomechanical testing measured elastic modulus and tensile strength.
- Crosslinked dura mater patches were used for PSR in 57 adult patients with pathologic myopia, followed for an average of 3 years.
Main Results:
- Crosslinked dura mater exhibited comparable weight loss to crosslinked sclera after enzymatic degradation but possessed a higher density.
- The elastic modulus of crosslinked dura mater (72.02 MPa) was significantly higher (34%) than that of crosslinked sclera (53.88 MPa) post-enzyme exposure (P=0.0186).
- After 3 years, a mean reduction of 1.29 mm in axial length was observed (P<0.0001), and best-corrected visual acuity improved by 0.10 logMar units (P=0.0184). No material-specific complications occurred.
Conclusions:
- Genipin-crosslinked human dura mater demonstrates superior biomechanical resilience compared to crosslinked sclera.
- Dura mater serves as a safe and effective reinforcing material for posterior scleral reinforcement in managing high myopia progression.
- This biomaterial shows promise for improving ocular structural integrity and visual outcomes in patients with pathologic myopia.
