Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations

Abstract

Objective: To compare the efficacy of fibrin glue and N-butyl-2-cyanoacrylate in corneal perforations.

Design: Randomized, controlled clinical trial.

Participants: Forty-one patients (41 eyes) with corneal perforations up to 3 mm in diameter with a positive Seidel's test were randomly assigned to two groups (1 and 2).

Intervention: Group 1 comprised 19 eyes treated with fibrin glue, and group 2 comprised 22 eyes treated with N-butyl-2-cyanoacrylate.

Main outcome measures: Number of eyes with successful healing, time required for healing, status of corneal vascularization, and complications were compared in the two groups. Power calculation was performed at alpha = 0.05.

Results: Fifteen (79%) eyes had successful healing of corneal perforation in group 1, compared with 19 (86%) eyes in group 2 (P > 0.05) at 3 months' follow-up. The power to detect a difference between the two groups was 10%. Corneal perforation healed within 6 weeks in 12 (63%) eyes in group 1 and 7 (31.8%) eyes in group 2 (P < 0.05). Reapplication of glue was required in six (31.5%) eyes in group 1 and seven (31.4%) eyes in group 2 during the first 3 months of follow-up. The mean number of applications per eye was 1.37 in group 1 and 1.36 in group 2. An increase in deep corneal vascularization was observed in 2 (10.5%) eyes in group 1 and 10 (45.5%) eyes in group 2 (P < 0.05). Giant papillary conjunctivitis occurred in one (5%) eye in group 1 and eight (36.4%) eyes in group 2 (P < 0.05).

Conclusions: Fibrin glue and cyanoacrylate tissue adhesive are both effective in the closure of corneal perforations up to 3 mm in diameter. Fibrin glue provides faster healing and induces significantly less corneal vascularization, but it requires a significantly longer time for adhesive plug formation.