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shuyan zhu, Jia Yin, Rohan Bir Singh, Rani Al Karmi, Ann Yung, Man Yu, Reza Dana; Use of cyanoacrylate glue in corneal thinning and perforation associated with infectious keratitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3231.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal perforation and severe thinning of the stroma (descemetocele) are ophthalmic emergencies that require prompt intervention to retain ocular integrity and visual function. Cyanoacrylate glue is a first-line, albeit off-label, treatment for corneal perforation. Infectious keratitis is a major cause of corneal perforation; and in this study, we examine the etiologies underlying corneal thinning and perforation associated with infectious keratitis, and the outcome of cyanoacrylate glue application in these cases.
A retrospective interventional case series of 74 patients with infectious keratitis who received CTA for corneal thinning and perforation between 2001 and 2018 at a single-center was reviewed. Infection was diagnosed clinically and/or based on culture, pathology or confocal microscopy findings. Success rate of glue application, defined as intact globe without surgical intervention, was reported.
Median age of the cohort was 66.5 years and 44 (59.5%) were female. Forty-two eyes (56.8%) presented with perforation while 32 (43.2%) with thinning. The perforation/thinning was central/paracentral in 47 eyes (63.5%) and peripheral in 26 eyes (35.1%). Median size of perforation was 3.4 mm2. Etiologies underlying perforation/thinning were bacterial (62 eyes, 83.8%), viral (2), fungal (3), acanthamoeba (2), and polymicrobial (5 eyes). Infectious organisms were identified by culture of corneal scraping in 58 eyes (78.4%): Staphylococcal species (30), pseudomonas (10), streptococcal species (10), diphtheroids (8), other bacteria (12), fungus (1), and acanthamoeba (1). One case of acanthamoeba and one case of fungal keratitis were identified by confocal microscopy and pathology, respectively, despite initial negative culture results. Success rate of glue application was 70%, 61% and 49% at 10, 30 and 90 days post-glue application, respectively.
Bacterial infection underlies the majority of corneal thinning and perforations that require cyanoacrylate glue application in this series. Cyanoacrylate glue application is relatively successful in restoring globe integrity in the short term.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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