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

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.