An Eye Bank and Ex Vivo Pilot Study of Shelf-Stable Corneal Plugs for Perforation Repair

Cyanoacrylate tissue adhesive with a plastic disc (CTA-D) is the standard in-office treatment for corneal perforations but often requires reapplication because of reliance on surface adhesion. We developed a cufflink-shaped corneal plug that provides a sutureless intraocular seal by mechanical anchoring. This study evaluated feasibility of eye bank microkeratome production, ex vivo performance compared with CTA-D, and burst pressure testing in whole human globes.

Cufflink plugs were produced from 1-month glycerin-preserved donor corneas by an eye bank technician using a microkeratome-based cutting system. Dimensional accuracy was assessed after 1 week of storage. Plugs were tested against CTA-D in corneoscleral rims with simulated 1- and 2-mm perforations. The sealed rims were mounted on artificial anterior chambers for burst pressure testing. Whole globes with simulated 2-mm perforations sealed by plugs were tested for burst pressure.

Ten plugs were produced with acceptable dimensional accuracy; asymmetry was observed between the leaflets but remained within functional tolerances. In ex vivo corneoscleral rim testing, plugs trended toward higher burst pressures than CTA-D for 1-mm (381 ± 108 vs. 318 ± 142 mm Hg) and 2-mm perforations (346 ± 93 vs. 289 ± 90 mm Hg). In five whole globes, plugs maintained seals above physiological pressures (minimum: 112 mm Hg), and no dislodgement was observed.

Eye bank technicians can reliably produce cufflink-shaped corneal plugs using modified microkeratome systems. Plugs demonstrated strong sealing capacity in both corneoscleral rim and whole globe models. Future animal and human studies are needed to evaluate safety, tissue integration, and long-term stability.