Current and future applications of intraocular bioadhesives in vitreoretinal surgery

Achieving retinal adhesion and tissue healing in rhegmatogenous retinal detachment repair has been explored using numerous methods since the foundational principles established by Jules Gonin. Current approaches rely on delayed chorioretinal adhesion through thermal injury and inflammatory-mediated scarring. Intraocular bioadhesives (IOBs) offer an alternative strategy, providing efficient sealing of retinal breaks, and abrogating reliance on tamponade agents and their associated morbidities. Despite this, no IOBs are currently licensed for vitreoretinal surgery with limited clinical data to support biocompatibility and safety. We summarize the development and application of IOBs in vitreoretinal surgery, specifically cyanoacrylate, fibrin, polyethylene glycol, and transforming growth factor-beta. Biochemical properties, historical use, and performance are reviewed in context to retinal detachments, macular holes, optic disc maculopathy, and diabetic vitrectomy. We discuss trade-offs between tensile strength and biocompatibility, alongside surgical approaches. We also consider novel alternatives in early clinical studies (foldable capsular vitreous bodies and retinal tacks), and experimental studies (vitreous substitutes and thermofusion). Potential future applications of next-generation IOBs include intraocular drug delivery, treatment of open globe injuries, and sutureless repair of conjunctival and corneal defects. The current research gaps highlighted provide a foundation for addressing unmet needs in vitreoretinal surgery.