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Outcomes of Cyanoacrylate Tissue Adhesive Application in Corneal Thinning and Perforation

Yin, Jia, MD, PhD; Singh, Rohan Bir, MD; Al Karmi, Rani, MD; Yung, Ann; Yu, Man, MD; Dana, Reza, MD, MSc, MPH

doi: 10.1097/ICO.0000000000001919
Clinical Science

Purpose: To report the outcomes of cyanoacrylate tissue adhesive (CTA) application in corneal thinning and perforation.

Methods: A retrospective interventional case series of 137 patients receiving CTA for corneal thinning and perforation in 140 eyes between 2001 and 2018 at a single center was reviewed. Success rate and factors associated with glue failure were analyzed.

Results: Median age of the cohort was 63 years and 69 (50%) were women. One hundred fifteen patients (84%) had at least 1 systemic condition, 46 (34%) had autoimmune diseases. Eighty-nine eyes (64%) presented with perforation and 51 (36%) with thinning. The perforation/thinning was central/paracentral in 82 eyes (59%) and peripheral in 57 eyes (41%). Median size of perforation was 3.1 mm2. Causes of perforation and thinning were microbial infection in 75 (55%), sterile melt in 49 (35%), laceration in 10, and keratoprosthesis melt in 8 eyes. Median glue retention was 58 days. Success rate of glue application (defined as intact globe without surgical intervention) was 72%, 61%, and 46% at 10, 30, and 90 days after glue application, respectively. Larger size of perforation/thinning, perforation (vs. thinning), and single glue application (vs. multiple) were correlated with higher failure rate. Systemic conditions, use of topical corticosteroid, etiologies, and location of perforation/thinning were not significantly correlated with glue failure.

Conclusions: CTA application was moderately effective in stabilizing corneal perforation and thinning in the very short-term. Multiple applications are often required. Maintenance of globe integrity after glue application decreases with time and the need for surgical intervention remains high.

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Correspondence: Jia Yin, MD, PhD, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 (e-mail:

Supported by the National Eye Institute 5K12EY016335 (J. Yin, trainee). The sponsor or funding organization had no role in the design or conduct of this research.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 19, 2018

Received in revised form January 19, 2019

Accepted January 23, 2019

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