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Scleral Patch Graft Augmented Cyanoacrylate Tissue Adhesive for Treatment of Moderate-Sized Noninfectious Corneal Perforations (3.5–4.5 mm)

Sharma, Ashok MS; Mohan, Kanwar MS; Sharma, Rajan MBBS; Nirankari, Verinder S. MD

doi: 10.1097/ICO.0b013e31829cb625
Clinical Science

Purposes: To describe a new technique of scleral tissue augmented cyanoacrylate tissue adhesive (CTA) application and to evaluate its efficacy in noninfectious corneal perforations that measure between 3.5 and 4.5 mm.

Methods: Retrospective noncomparative case series included 16 consecutive patients diagnosed with moderate-sized corneal perforations measuring 3.5 to 4.5 mm who were treated with scleral patch graft augmented glue application. A partial-thickness scleral patch equal to the size of corneal perforation was placed in the corneal perforation site. After the area was sufficiently dried, CTA was applied on the interface of the host cornea and scleral patch. The ability of the scleral patch graft with CTA to seal the perforation and allow complete wound healing was considered a successful outcome.

Results: The corneal perforation healed in 14 eyes (87.5%), with a mean of 5.65 weeks (range, 5–9 weeks). One eye (6.25%) developed microperforation that required additional CTA to seal the wound. Three eyes (18.75%) required reapplication of the scleral patch graft and CTA. The 2 eyes (12.50%) that failed scleral patch with CTA were successfully treated with tectonic penetrating keratoplasties. In all 5 eyes (100%), the corneal perforations as a result of Mooren ulcer healed in a mean 5.80 weeks (range, 5–7 weeks). One patient developed retinal detachment with proliferative vitreoretinopathy and cataract after trauma.

Conclusions: Scleral patch graft augmented CTA technique is a successful alternative treatment method to emergent penetrating keratoplasty for corneal perforations that measure 3.5 to 4.5 mm.

Supplemental Digital Content is Available in the Text.

*Cornea Centre, Chandigarh, India;

Squint Centre, Chandigarh, India;

Cornea Service, Eye Consultants of Maryland, Owings Mills, MD; and

§Department of Ophthalmology, University of Maryland, Baltimore, MD.

Reprints: Ashok Sharma, Cornea Centre, SCO 833-834, Sector 22A, Chandigarh 160022, India (e-mail:

Presented at the American Academy of Ophthalmology Annual Meeting, Chicago, IL, November 10–13, 2012.

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The authors have no funding or conflicts of interest to disclose.

Received December 27, 2012

Accepted May 18, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.