CYANOACRYLATE GLUE USE FOR TRAUMATIC CORNEAL PERFORATIONS

The purpose of our 3 cases is to describe the surgical management with cyanoacrylate glue and highlight the difficulties and outcomes.

Mohammed V University, University Hospital Ibn Sina Rabat, Departement A of Ophthalmology, Morocco

We report 3 cases of traumatic corneal perforation of diameter less than 2 mm with foreign body in which we proceeded to the ablation of the foreign body under general anesthesia followed by closing of the perforation by a cyanoacrylate glue. A paracentesis was performed to fill the anterior chamber with ophthalmic viscoelastic device (OVD). The next step was  epithelial scarification was performed on an area 2 mm including the perforation. Then we proceeded to the preparation of the glue pad by droping the round back of the micro-sponge rod with glue and removing the excess by tapping it gently  on a smooth surface. The glue was applied  on the 2mm circle like a stamp. After that, we did an hydrosuture or paracentesis closure with a 10.0 monofilament tip after cleaning intracameral OVD. Finally, we injected intracameral antibio-prophylaxis before placement of a soft lens bandage

The major complication of the use of cyanoacrylate glue is the toxicity to the corneal endothelium and the lens when it is in direct contact with these structures. Our surgical technique aims to avoid excess of cyanoacrylate glue deposit on the clear cornea and to prevent the glue from passing into the anterior chamber (toxicity). In the immediate postoperative period, we obtained excellent sealing of the anterior chamber with closure of the perforation. Scarification allows better adhesion of the glue to the corneal surface and increases the success. the application of a thin layer of the adhesive which exceeds the surface of the perforation prevents penetration into the anterior chamber. In the first case, the applied glue was spontaneously detached after ten days. The second patient underwent transfixing keratoplasty with excellent results. The last patient was scheduled for transfixing keratoplasty. All cases were managed in the post-operative period by antibiotics and anti-inflammatory drugs with regular change of the bandage lens. We noted any infectious complication in all cases. In one case the full thickness defect was tunnel shaped. Thus, OCT based monitoring of the healing process was limited by the mask effect of the glue. 

Corneal patching with cyanoacrylate glue is a temporizing procedure only, buying time to allow healing secondary to medical treatment of the underlying condition, or allowing surgery to be elective and under more optimal conditions once inflammation has been reduced and the integrity of the globe restored. Further procedures are not always required, although when needed, the restored integrity of the globe following application of cyanoacrylate glue makes these procedures more successful.