Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions

Abstract

Corneal perforations are ophthalmological emergencies which can have serious and detrimental consequences, if not managed timely and appropriately. These are a significant cause of ocular morbidity and can result in decreased vision, blindness, and even loss of the eye. Corneal perforations can be managed using a range of treatment approaches, including temporary solutions such as the application of corneal glue and bandage contact lens, as well as definitive treatment such as corneal transplantation. Tissue glues/adhesives were developed as substitutes for sutures in ophthalmic surgery. Unlike sutures, these glues are associated with shorter overall surgical times and reduced inflammation, thus improving postoperative comfort without compromising wound strength. The available tissue adhesives can be broadly classified into two types: synthetic (eg, cyanoacrylate derivatives) and biological (eg, fibrin glue). Cyanoacrylate glue is chiefly used as a corneal patch to manage acute corneal perforations and improve visual outcomes. Fibrin glue can be used instead of cyanoacrylate glue in many conditions with the benefits of reduced conjunctival and corneal inflammation and reaction. Apart from this, each type of adhesive is distinct in terms of its benefits as well as limitations and is accordingly used for different indications. The present review focuses on the two main types of tissue adhesives, their applications in the management of corneal perforations, the associated complications, safety and efficacy data related to their use available in the literature and the need for newer adhesives in this field.

Smart molecules in ophthalmology: Hydrogels as responsive systems for ophthalmic applications

“…Histoacryl ® , Nexacryl ® , Dermabond ® ) involves a wide range of clinical conditions, such as corneal perforations, neurotrophic or chemical keratitis, corneal melts, and bleb leaks following glaucoma surgery. [148] They have shown to be efficient in their ability to halt keratolysis progression with added antibacterial activity. [149] Although, a major concern regards their cytotoxicity to the corneal endothelium and intraocular lens.…”

“…Furthermore, for perforations larger than 3 mm, cyanoacrylate-based glue use comes with its challenges: leakage into the anterior chamber through the perforation hole could lead to the development of cataracts, glaucoma, or granulomatous keratitis. [148] Therefore, in these specific cases, suturing may be inevitable. Fibrin adhesives (i.e.…”

“…The off‐label applications of cyanoacrylate‐based glues ( i.e. Histoacryl ® , Nexacryl ® , Dermabond ® ) involves a wide range of clinical conditions, such as corneal perforations, neurotrophic or chemical keratitis, corneal melts, and bleb leaks following glaucoma surgery [148] . They have shown to be efficient in their ability to halt keratolysis progression with added antibacterial activity [149] .…”

“…They were shown to induce acute inflammation and infection complications, as well as precipitate cataracts, processes that could inevitably aggravate the underlying eye condition. Furthermore, for perforations larger than 3 mm, cyanoacrylate‐based glue use comes with its challenges: leakage into the anterior chamber through the perforation hole could lead to the development of cataracts, glaucoma, or granulomatous keratitis [148] . Therefore, in these specific cases, suturing may be inevitable.…”

Neurotrophic keratitis: inflammatory pathogenesis and novel therapies

“…In severe cases of NK with corneal perforation, and depending on the size of the perforation, therapeutic strategies such as corneal gluing with tissue adhesives [59], contact lenses, lamellar corneal transplant (mini-Descemet's stripping automated endothelial keratoplasty) [60], small patch graft and therapeutic penetrating keratoplasty with or without amniotic membrane transplants and tarsorrhaphy can be necessary along with many of the aforementioned strategies above. Healing can be lengthy, and ulcers can be refractory.…”