@article {1593841,
	title = {Biomechanical testing of flanged polypropylene sutures in scleral fixation},
	journal = {Am J Ophthalmol},
	year = {2021},
	month = {2021 May 01},
	abstract = {OBJECTIVE: To optimize the flanged belt-loop technique of scleral fixation through biomechanical testing and report clinical outcomes of resultant modifications. DESIGN: Experimental study. METHODS: The force to disinsert flanged polypropylene suture from human cadaveric sclera was assessed using a tensile testing machine and compared to the breaking strengths of 9-0 and 10-0 polypropylene. The effects of modifying suture gauge (5-0, 6-0, 7-0 or 8-0), amount of suture cauterized (0.5 or 1.0mm), and sclerotomy size (27-, 30-, 32-, 33-gauge) were investigated. Belt-loop intrascleral fixation using 6-0 and 7-0 polypropylene with 30- and 32-gauge needles respectively was performed in 5 patients. MAIN OUTCOME MEASURES: Flanged suture disinsertion force in cadaveric sclera. RESULTS: The average force to disinsert a flange created by melting 1.0mm of 5-0, 6-0, 7-0 and 8-0 polypropylene suture from human cadaveric sclera via 27-, 30-, 32- and 33-gauge needle sclerotomies was 3.0 {\textpm} 0.5N, 2.1 {\textpm} 0.3N, 0.9 {\textpm} 0.2N and 0.4 {\textpm} 0.1N respectively. The disinsertion forces for flanges formed by melting 0.5mm of the same gauges were 72-79\% lower (p \&lt; 0.001). In comparison, the breaking strengths of 9-0 and 10-0 polypropylene were 1.0 {\textpm} 0.2N and 0.5 {\textpm} 0.0N. Belt-loop fixation using 6-0 and 7-0 polypropylene with 30- and 32-gauge sclerotomies demonstrated good outcomes at 6 months. CONCLUSIONS: The flanged belt-loop technique is a biomechanically sound method of scleral fixation using 1.0mm flanges of 5-0 to 7-0 polypropylene paired with 27-, 30- and 32- gauge sclerotomies. In contrast, 8-0 polypropylene and 0.5 mm flanges of any suture gauge will likely be unstable with this technique.},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2021.04.017},
	author = {Yuan, Amy and Ma, Kevin and Sharifi, Sina and Pineda, Roberto}
}
