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D.L. Miele, T. Semchyshyn, N.A. Afshari; Effectiveness of Cyanoacrylate Tissue Adhesive for Corneal Perforation . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4700.
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Purpose: To evaluate the efficacy of cyanoacrylate tissue adhesive for the management of corneal perforation. Methods: Retrospective study of patients with corneal perforation ≤2mm in size at the Duke University Eye Center between 1996 and 2002. Etiology of perforation, incidence of secondary application of cyanoacrylate tissue adhesive due to recurrent perforation, secondary need for penetrating keratoplasty (PK), visual outcome and complications related to the application of tissue adhesive were studied. Results: Of the 70 patients with corneal perforation, twenty-one eyes of twenty patients underwent the application of cyanoacrylate tissue adhesive. Ten (48%) of the twenty-one were due to rheumatologic disease, four (19%) to keratoconjunctivitis sicca, three (14%) to bacterial keratitis and one (5%) to each of atopic keratoconjunctivitis, herpes simplex keratitis, neurotrophic ulcer, and Stevens-Johnson syndrome. Thirteen (62%) of the patients who received tissue adhesive healed without a need for further intervention. Two patients proceeded to penetrating keratoplasty (PK) after the adhesive dislodged and the perforation failed to heal. In six patients (29%), the tissue adhesive was used as a temporizing measure to seal the perforation and form the anterior chamber prior to PK. These patients all proceeded to PK from one to fourteen days following perforation. Visual acuity improved in seven patients (33%) by two or more Snellen lines. The most common complication was the need for re-application of tissue adhesive. Three of the healed patients required more than one application of tissue adhesive. Two patients proceeded to PK due to severe stromal scarring limiting visual acuity, after their perforations had healed with the application of tissue adhesive. There were no cases of endophthalmitis, despite the fact that three patients had perforated bacterial keratitis. Conclusions: Cyanoacrylate tissue adhesive is effective in sealing the majority of small non-traumatic corneal perforations. In addition, it is a useful temporizing measure to obtain structural integrity in patients with corneal perforation, who require PK, but in whom surgical intervention must be temporarily delayed.
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