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Rohan Bir Singh, Rani Al Karmi, Man Yu, Jia Yin, Reza Dana; Outcomes of Cyanoacrylate Glue Application for Corneal Perforation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4349.
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© ARVO (1962-2015); The Authors (2016-present)
Application of cyanoacrylate glue to seal corneal perforation is a common clinical practice, but its outcome has not been systematically studied. We examined the outcome of cyanoacrylate glue application for corneal perforation and thinning in order to identify the variables associated with unsuccessful gluing.
A retrospective chart review was performed for 90 patients, treated for corneal perforation and thinning. Exclusion criteria included: Patients younger than 18 years old, keratoprosthesis melt, and suture leakage. Unsuccessful sealing of corneal perforation was defined as an application of cyanoacrylate more than once due to either continuation of leakage or dislodgment of the glue and/or corneal perforation not being sealed after the application of glue, calling for surgical intervention with a corneal patch or therapeutic penetrating keratoplasty.
64 patients (65 eyes) met our inclusion criteria for treatment with cyanoacrylate glue for corneal perforation and thinning. Mean age of patients was 60.54 ± 19.67(SD) years. Most commonly encountered causes of perforation were infectious ulcer 23/65 (35.4%), autoimmune diseases such as Graft Versus Host Disease and Rheumatoid Arthritis 21/65 (32.3%), trauma 16/65 (24.6%), and unspecified melt 5/65 (7.7%). The application of cyanoacrylate was unsuccessful in sealing perforations in 35/65 (54%) of reviewed cases. Unsuccessful cases 28/35(78.9%) were patched or grafted while successful re-gluing without surgical intervention occurred in only 7/35(20%) of cases. A higher rate of unsuccessful application was observed in perforations caused by autoimmune diseases (40%), infectious ulcers (42.9%), and least common in trauma (17.1%). 82.1% of cases requiring surgical intervention were either autoimmune (35.7%) or infectious ulcer (46.4%).
Our analysis showed that gluing with cyanoacrylate is more likely to have unsuccessful outcomes in perforations caused by infectious ulcers or autoimmune diseases. Corneal perforations caused by infectious ulcers or autoimmune diseases are better sealed with surgical patching or grafting. Trauma-induced perforations are more likely to be successfully glued. The success of cyanoacrylate glue application can be predicted on the basis of the etiology of corneal perforation.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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