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Tissue adhesives efficacious in management of corneal perforation
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WAIKOLOA, Hawaii — Nicoletta Fynn-Thompson, MD, gave pearls for using tissue adhesives for the management of corneal perforation here at Hawaiian Eye 2016.
“Tissue adhesives work very well. We use these for impending perforations and also frank perforations,” Fynn-Thompson said. “The size of the perforation is important. Generally larger sizes will not work well because you are not able to seal.”
Nicoletta Fynn-Thompson
Frank perforations are more difficult to glue due to constant outflow of aqueous fluid. Fynn-Thompson encouraged surgeons to place a bubble into the anterior chamber to avoid pupillary block and inject viscoelastic into the eye to tamponade the fluid and seal the perforation.
The two options that have shown to be useful are cyanoacrylate adhesive and fibrin glue, she said.
“The advantages of [fibrin glue] are that it is less inflammatory, so there is less neovascularization associated with that and it is faster healing, but it does take a longer time for the plug to form,” she said.
Fynn-Thompson recommends surgeons to have a thorough exam to assess the patient.
“You need to see the extent of the perforation and determine whether or not there is lenticular damage or uveal perforation,” she said.
It is very important to place a large diameter contact lens after applying the tissue adhesive into the eye to prevent dislodging of the glue and provide more comfort for the patient, Fynn-Thompson said.
If this is a noninfectious perforation, you need to use topical antibiotics, but if it an infectious etiology then of course we are going to aggressively treat that infectious etiology,” she said.
Complications of tissue adhesive application are cataract formation, corneal infiltrates, increased IOP, giant papillary conjunctivitis, retinal toxicity and iridocorneal and iridolenticular adhesions. – by Nhu Te
Reference:
Fynn-Thompson N. Management of corneal thinning, melting and perforation. Presented at: Hawaiian Eye 2016 meeting; Jan. 16-22, 2016; Waikoloa, Hawaii.
Disclosure: Fynn-Thompson reports she is a consultant to Beaver-Visitec.