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Need for surgery remains high after use of cyanoacrylate tissue adhesive
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Application of cyanoacrylate tissue adhesive in eyes with corneal perforation and thinning is moderately effective in the short term but often requires multiple applications, and eventually surgery may be needed.
A study investigated long-term retention of cyanoacrylate tissue adhesive (CTA) and maintenance of globe integrity in 137 patients treated at Massachusetts Eye and Ear, Boston, between 2001 and 2018. Corneal melting and subsequent perforation or thinning were due to a variety of infectious and immune disorders or ocular trauma, prevalently infectious keratitis, which affected approximately half of the patients.
A single CTA application was successful in restoring corneal integrity in approximately half of the patients at 10 days, but almost two-thirds of the patients required a second application or surgery within 1 month. Multiple applications were significantly correlated with a lower failure rate, but efficacy in maintaining an intact globe declined over time. Perforation vs. thinning and larger size of perforation or thinning were associated with a higher failure rate. Autoimmune conditions and ocular surface disease were present in a high proportion of patients but did not correlate with failure, and neither did the use of systemic immunosuppression or topical corticosteroids. No correlation was found with age, sex, location and etiology of the lesion.
Maintenance of globe integrity following CTA application decreases with time, and the need for surgery remains high, the authors said. However, they said that careful monitoring and repeated applications might in some cases delay the need for surgery.
“Our study suggests that eyes that have had cyanoacrylate glue application should be monitored closely, and repeat glue application needs to be considered before proceeding to surgery,” they wrote. – by Michela Cimberle
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Preeya K. Gupta, MD
This study shows that CTA application was successful in restoring globe integrity with a single application in nearly 50% of patients. However, two-thirds of the patients required a second procedure such as further glue or surgical intervention. Perforation and/or a large area of thinning were associated with CTA failure. There is a need for improved treatments for corneal thinning and perforation, with hopefully a higher rate of success.
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