Cyanoacrylate Tissue Adhesive for the Treatment of Corneal Thinning and Perforations: A Multicenter Study

Abstract

Purpose: To examine the outcomes of cyanoacrylate tissue adhesive (CTA) application for impending or frank corneal perforations and assess for predictors of treatment response. Methods: A multicenter cohort study was conducted to assess the clinical outcomes of adult patients who underwent CTA gluing for impending or frank corneal perforations between 2013 and 2018. The primary outcome was the proportion of successful CTA applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity and success of subsequent surgical interventions, if performed. Results: Fifty-three eyes of 52 patients were included in this study [56% women; mean age at presentation 70 ± 13 years; median length of follow-up of 387 days (interquartile range: 191–704)]. Medical comorbidities were present in 62% of patients. The most common etiologies for perforations included infections (43%) and Sjogren disease (9%). Of the CTA-treated eyes, 22% had a complete resolution of the corneal lesion. Fifty-four percent of patients underwent KP. Longer duration of CTA treatment was associated with CTA success (P = 0.04). For patients requiring KP, 71% were successful and 29% failed. There is no significant difference in the median time delay between patients with successful and failed KPs (P = 0.4). Conclusions: CTA may be considered a stand-alone treatment for corneal perforations. It yielded a success rate of 22%. Failed CTA treatment occurred quickly, largely because of the severity of presentation. In cases requiring KP, the delay between glue application and surgery did not influence the PK success.

Histoacryl-Kleber zur Akutversorgung von Hornhautperforationen bei nekrotisierender herpetischer Keratitis

“…Das Hornhautkleben stellt in Augenkliniken ohne Transplantationskompetenz eine valide Behandlungsoption dar [ 5 , 11 , 13 ]. Sie bietet eine tektonische Unterstützung und erhält vorübergehend die strukturelle Integrität des Bulbus.…”

“…Darüber hinaus wird die Vorderkammer formiert, und zirkuläre vordere Synechien mit konsekutivem Winkelblockglaukom werden vermieden. Trotzdem wird eine elektive PKP zur visuellen Rehabilitation zu einem späteren Zeitpunkt erforderlich sein [ 11 – 13 ]. Die Verzögerung der perforierenden Keratoplastik durch den Einsatz von Hornhautkleber führt in der Regel nicht zu schlechteren Ergebnissen [ 13 ].…”

“…Trotzdem wird eine elektive PKP zur visuellen Rehabilitation zu einem späteren Zeitpunkt erforderlich sein [ 11 – 13 ]. Die Verzögerung der perforierenden Keratoplastik durch den Einsatz von Hornhautkleber führt in der Regel nicht zu schlechteren Ergebnissen [ 13 ].…”

“…Der Hauptnachteil biologischer Klebstoffe besteht darin, dass sie viel schneller abgebaut werden als synthetische Klebstoffe. Zusätzlich haben sie keine bakteriostatische Wirkung (wie synthetische Klebstoffe) [ 5 , 13 , 14 ]. Bei einer Hornhautperforation ist die Angabe über die Erfolgsrate in der Literatur sehr umstritten und variiert zwischen 22 und 73 % [ 13 , 15 ].…”

A Liquid Hydrogel to Restore Long Term Corneal Integrity After Perforating and Non-Perforating Trauma in Feline Eyes

“…It can also trigger inflammation, scarring and vascularization, and it does not prevent infection. Hence, it is a temporary solution requiring more than one application while waiting for a human amniotic membrane patch or a lamellar or full-thickness corneal graft ( Vote and Elder, 2000 ; Anchouche et al, 2020 ).…”