Beyond ‘Shield and Ship’: a novel device (Eye-Aid) to provide temporary aqueous tamponade
Reviewed by Ben Smith

The authors present a pilot efficacy study of the novel Eye-Aid device in a porcine model of full-thickness corneal wounds to mitigate anterior chamber collapse in the forward military environment. Currently, the ‘Shield and Ship’ paradigm taught to military healthcare providers teaches the placement of a rigid eye shield and administration of antibiotics, analgesia and anti-emesis. However, with modern conflict placing significant delays on evacuation timelines, this device could present a step toward improved care of open globe injury in the forward environment. Fourteen male swine were sedated and intubated with bilateral eye preparation involving speculum placement and baseline A-scan and intraocular pressure (IOP) measurements. A 5mm 16-gauge needle was used to create a central corneal full-thickness wound. Eye-Aid systems were placed bilaterally two minutes after the injury was created. On a given swine, eyes were randomised using coin flip to decide which would have foam deployed (intervention) and which would be the control eye. This foam flows from a canister into the eye shield, creating a tamponade effect. Six hours post-injury, eye shields and foam were removed. Repeat IOP and A-scan was performed as well as tissue analysis of the globes. There was statistically significant improvement in the primary outcome (mean change in axial length) and all secondary outcomes (IOP and anterior lens-capsule reflex on A-scan) compared to control with no histopathological differences noted between groups. This novel in-vivo model and novel thermoreversible hydrogel improves upon other in vivo models and has demonstrated effective tamponade of the globe. Further work on mixed injury types (rather than only zone 1), non-speculum opened eyes in a mix of environments (such as those found in the military) will enable development of this potentially useful tool in the acute management of open globe injury.

Novel thermoreversible reverse-phase-shift foam with deployment system for treatment of penetrating globe trauma in a newly described porcine model.
Donaldson RI, Choue E, Tanen DA, et al.
MILITARY MEDICINE
2024;189:254–61.