Anterior Segment Optical Coherence Tomography Guided Assessment Of Wound Healing After Cyanoacrylate Glue Patch For Corneal Perforations

To evaluate wound healing after cyanoacrylate glue patch (CGP) application in corneal perforations using anterior segment optical coherence tomography (ASOCT).

Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 

28 patients with corneal perforations (<4 mm) undergoing CGP application. Primary outcome measure was wound healing pattern on ASOCT after CGP application. Secondary outcomes were time to removal of CGP, and anatomical success. Follow up was performed on POD 1 and every 2 weeks till CGP removal.

Three distinct wound healing patterns were observed- Type 1 with corrugated hyper-reflective mass with underlying shadowing ,Type 2 pattern with ongoing stromal regeneration without continuity with surrounding healthy cornea and Type 3 with complete stromal regeneration continuous with surrounding cornea. On POD 1, 100% cases had type 1 pattern. At 4 weeks, 35.7% cases had type 3 and 64.3% had type 2 pattern. Five cases underwent early glue removal at 31.8 ± 2.5 days because of CGP intolerance; of these, 40% developed a leak and required re-application of CGP. Total 82.1% cases achieved type 3 pattern by 8 weeks. CGP was removed after documentation of type 3 pattern in 82.1% cases at 41.7 ± 9.2 days; no case developed wound leak.

ASOCT is a useful adjunct to objectively monitor wound healing after CGP and guide regarding optimal timing for its removal, with type 3 pattern correlating with higher anatomical success.