Cyanoacrylate As An Effective Alternative In The Treatment Of Perforated Neurotrophic Ulcer

To analyze the effective application of a corneal patch with cyanoacrylate glue as a provisional treatment of corneal perforation caused by neurotrophic ulcer. Cyanoacrylate glue is known to prevent re-epithelialization in the area of ​​damaged and exposed stroma, as well as the development of the critical environment for collagenase production leading to stromal fusion. It also have significant bacteriostatic activity against gram-positive organisms. The main disadvantage described is the toxicity in direct contact with the corneal endothelium. To date, it is considered only a temporary procedure, buying time to allow healing secondary to medical treatment of the underlying condition, or allowing surgery to be elective.

An 88-year-old man presented sudden loss of vision in right eye with mydriasis, conjunctival hyperemia and eye pain. He has an ophthalmological history of long-standing corneal ulcer. Ocular perforation with perilesional thinning and adjacent nasal ulcer, associated with atalamia and hypotonia, was observed. Surgical intervention was performed to seal the perforation and ulcer with cyanoacrylate plates. After a month with oral Doxycycline every 24 hours and topical Idroflog and Moxifloxacin every 8 hours we observed the two correctly adhered cyanoacrylate plates, with a good anterior chamber. From then on, he maintains Idroflog every 12 hours and Ozonest every 8 hours, in addition to Therapeutic Contact Lens, with monthly replacement. 

Follow-up has been carried out for 3 months in which the efficacy of cyanoacrylate has been confirmed as a temporary measure to treat perforation, still maintaining the plaque adhered to the central area and with spontaneous fall of the plaque on the nasal ulcer, already resolved. Currently, the patient presents inferior neovascularization towards the central area that was perforated, with areflexic mydriasis, but maintaining good Anterior Camera. Ciprofloxacin treatment is continued every 12 hours, with Therapeutic Lens. It is valued as a definitive measure to carry out an amniotic membrane transplant soon.

In the management of ocular perforation, treatment, although not definitive, with cyanoacrylate glue has proven to be effective in this case and should be considered as an alternative in this type of pathology given its satisfactory provisional results and accessibility.