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.

Keywords: corneal patch; corneal perforation; cyanoacrylate; fibrin glue; tissue adhesives.

Figure 1

Demonstrates positive Seidel’s test.

Figure 2

Shows cyanoacrylate tissue adhesive in post bacterial keratitis perforation. (A) Corneal perforation before glue application (A1) Magnified view. (B) After cyanoacrylate tissue adhesive application at 1 week, (B1) Magnified view. (C) Healed corneal perforation with resultant corneal leucoma at 12 weeks (C1) Magnified view.

Figure 3

Shows cyanoacrylate tissue adhesive in post fungal keratitis perforation. (A) Corneal perforation before glue application. (B) After cyanoacrylate tissue adhesive application at 5 days. (C) Healed corneal perforation with resultant corneal leucoma at 14 weeks.

Figure 4

Shows successful healing in moderate corneal perforation using scleral patch augmented CTA application: (A) Moderate peripheral corneal perforation due to Mooren’s Ulcer. (B) Customised partial thickness scleral patch assisted glue application at 1 week. (C) After 10 weeks, glue removed and perforation healed. (D) Final healing resulting peripheral corneal opacity, minimal astigmatism and good visual acuity at 16 weeks.