Cyanoacrylate Glue Application Research Articles

Progression of corneal thinning and melting after collagen cross-linking for keratoconus.

To study the aetiology, diverse clinical manifestations, therapeutic interventions, and prognoses in patients with corneal thinning after collagen cross-linking (CXL) treatment. a retrospective observational study of all patients presenting with corneal thinning after collagen cross-linking, in a tertiary eye care hospital in south India from 2011 to 2017. Preoperative details were noted. Patients who presented with corneal thinning were subjected to investigative measures to assess thinning, received appropriate management, and underwent follow-up evaluations. Among the 12 patients, 8 were female and 4 were male, all of whom had undergone standard classical CXL. The duration between CXL and corneal melting/thinning onset varied from 5 to 12 years. Notably, among female patients, 2 were pregnant, 2 were lactating mothers, 1 was undergoing in vitro fertilization (IVF) treatment, and 1 had comorbid diabetes mellitus and hyperthyroidism. Clinical examination revealed corneal thinning accompanied by hypopyon in 1 patient, corneal perforation with shallow anterior chamber in 1 patient, and epithelial defect with crystalline deposit in another patient, the remaining patients exhibited corneal thinning. Corneal thinnest corneal thickness measurements ranged from 212 to 351 µm. Treatment approaches included penetrating keratoplasty (PKP) in 2 patients, deep anterior lamellar keratoplasty (DALK) in 1 patient, cyanoacrylate glue application in 1 patient, and awaiting DALK/PKP in three patients, 4 patients showing no signs of increased thinning. The incidence of corneal thinning after collagen cross-linking is less but fulminant, requiring timely and appropriate management to prevent visual complications.

Tenon patch graft repair in an unusual case of leaking wound after phacoemulsification

Leaking corneal incisions after phacoemulsification can be associated with devastating consequences and can lead to secondary complications including endophthalmitis, choroidal hemorrhage, and glaucoma. We report a case of leaking corneal wound after routine phacoemulsification at the site of corneal thinning associated with terrien marginal degeneration (TMD), which was missed preoperatively, consequently leading to this surgical complication. TMD is a rare form of ectatic corneal condition with a very slow progression. The main aim of treatment is to improve the vision and corneal integrity, owing to its uncertain etiology. Surgical intervention in TMD, however, has been advocated when perforation is imminent, but the chance of spontaneous and intraoperative perforation increases in cases with severe thinning of corneas resulting in poor visual outcomes as compared to non-perforated eyes. In our case, as an amniotic membrane or corneal tissue was not available at the time of presentation, we proceeded with a Tenon patch graft with the application of cyanoacrylate glue, following which a bandage contact lens was applied. This case highlights the importance of a meticulous preoperative workup of the patient to identify any abnormality of the cornea, especially at the incision sites, to avoid such complications during the surgery.

Cyanoacrylate glue for iatrogenic retinal breaks during vitrectomy in stage 5 familial exudative vitreoretinopathy.

To describe the role of cyanoacrylate glue in sealing iatrogenic retinal breaks (IRBs) during vitrectomy in stage 5 familial exudative vitreoretinopathy (FEVR) with funneled retinal detachment (RD). Nine eyes of nine patients diagnosed as stage 5 FEVR were treated with cyanoacrylate glue for IRBs during vitrectomy from July 2020 to January 2022. The clinical records, including patient information, surgical process, and follow-up examinations, were collected retrospectively. Anatomical outcomes and visual outcomes were summarized. The average age at surgery was 19.6 months (range: 3.8-41.1 months). The mean post-operative follow-up period was 12.5 months (range: 9.8-18.8 months). Before surgery, five eyes had an open-funnel RD and four eyes had a closed-funnel RD. All the preretinal fibroplasia membranes were removed as thoroughly as possible in the nine eyes. IRBs formed at the posterior pole in two eyes and peripheral retina in seven eyes. All the IRBs were sealed successfully by the cyanoacrylate glue when they appeared. At the final post-operative visit, eight eyes had partial retinal reattachment without progression of fibroplasia tissues, while one eye had total retinal redetachment. The rate for stable anatomical outcome was 88.9% (8/9) in this study. The visual testing available for seven eyes demonstrated light perception in five eyes and no light perception in two eyes. No severe perioperative glue-related complications were noted during the follow-ups. The application of cyanoacrylate glue may be an alternative therapy for IRBs in stage 5 FEVR surgeries, while the long-term efficacy and safety still need further investigation.

Clinical Features, Risk Factors, and Management of Candida Keratitis

ABSTRACT Background/Aims To determine the clinical features, predisposing factors, and management of infectious keratitis caused by Candida spp. Methods Retrospective chart review. Results The medical records of 52 patients (54 eyes) with Candida keratitis were available for statistical analysis. Thinning of the corneal stroma was identified in 34 eyes (63.0%), and corneal perforation occurred in 16 eyes (29.6%). Corneal thinning and perforation were more common in Candida albicans compared with non-albicans (P-val < .001, P = .09, respectively). The most common predisposing factors for Candida keratitis were topical steroid use (21 patients, 40.4%), previous corneal transplantation (17 patients, 32.7%), and preexisting ocular surface disease (15 patients, 28.8%). Fourteen eyes (25.9%) required cyanoacrylate glue application and 10 eyes (18.5%) underwent therapeutic penetrating keratoplasty (TPK). Conclusion Local immunosuppression and ocular surface disease play an important role in Candida keratitis. C. albicans appears to be more invasive compared with non-albicans spp.

A rare case of corneal perforation with glass perchlet fish

Penetrating ocular injuries following direct impact of fish are rare. A 26-year-old man presented to the emergency department with history of pain and blurring of vision following injury to the left eye due to the impact of glass perchlet fish. Ocular examination revealed best corrected visual acuity of log of minimum angle of resolution (logMAR) 0.18, eyelid edema, blepharospasm, and circumcorneal congestion. A full-thickness corneal laceration measuring 3 mm, confirmed by positive Seidel's test, and a partial-thickness corneal laceration measuring 1.5 mm were noted. Patient was managed by application of cyanoacrylate glue and bandage contact lens. We report the first case of corneal perforation by glass perchlet fish.

Management of simultaneous bilateral immune-mediated peripheral ulcerative keratitis.

Peripheral ulcerative keratitis (PUK) is a sight threatening disease, often immune mediated and can rapidly progress to corneal perforation. Here we report the successful management of simultaneous bilateral peripheral ulcerative keratitis presenting with corneal perforation with surgical intervention and systemic immunosuppression. A 41-year-old female presented with similarly located super-nasal peripheral ulcerative keratitis (PUK) in both eyes and focal area of adjoining scleritis in the left eye. Serological investigations for systemic immune-mediated conditions showed positive rheumatoid factor test. She underwent cyanoacrylate glue application in both eyes, and was started on topical and oral corticosteroids and oral immunomodulators, and the right eye stabilized. The left eye required a second surgical intervention with a corneal patch graft following which the condition stabilized. This case highlights the importance of investigating for an underlying systemic etiology in PUK and the role of systemic immunosuppression prior to and after surgical intervention in order to arrest the disease and prevent recurrences.

Management of small perforated corneal ulcers: Training model in mammalian eye to enhance surgical skills of residents.

To demonstrate a training technique on the mammalian eye for optimum Cyanoacrylate Tissue adhesive application in cases of perforated corneal ulcers. A full-thickness defect simulating a perforation was created on the goat's eye cornea to teach the technique of cyanoacrylate glue application in cases of corneal perforations to novice surgeons. This training model on the mammalian eye was tested by 10 residents at our centre. All the 10 candidates involved in our series were newly joined Cornea fellows with proficient skill in cataract surgeries and minor ophthalmic procedures such as suture removal, chalazion excision, pterygium removal and administration of an intravitreal injection. None of the candidates had prior experience of corneal surgeries. Each resident made an average of 4.4 attempts to seal the corneal defect, obtain a regular corneal surface and form the anterior chamber. This training model helps in mastering one of the skills of corneal surgeries.

Modified Contact Lens Sandwich Technique of Glue for Management of Medium to Large Corneal Perforations in the COVID Era.

The aim of this article is to describe a novel technique of gluing as an interim measure to provide tectonic support in cases of medium-sized to large-sized (3-6 mm) corneal perforations. Five eyes of five patients in which conventional cyanoacrylate glue application was not feasible, and therapeutic keratoplasty could not be performed in view of the unavailability of corneal tissues were included. Surgery to maintain integrity of the globe was performed, and a therapeutic keratoplasty was performed on tissue availability (mean interval of 7.4 days). On follow-up, all patients had a well-formed anterior chamber, and none of them had progression. The contact lens sandwich technique of glue was a feasible, reproducible, and economical technique during times of tissue unavailability such as the present COVID pandemic, in patients with medium to large perforated corneal ulcers.

Modified emulsion polymer isocyanate-gluing: A minor amendment in cyanoacrylate glue application

Modified emulsion polymer isocyanate-gluing: A minor amendment in cyanoacrylate glue application

Emulsion polymer isocyanate-gluing: Autologous epithelial transplant with cyanoacrylate glue application for small corneal perforations.

Cyanoacrylate glue (CG) is a commonly employed modality for sealing small corneal perforations. Presently, we describe the technique of emulsion polymer isocyanate (EPI)-gluing, a modification of its application, and its results in nine eyes with noninfectious, nontraumatic sterile corneal perforation with size ≤3 mm. The method involves harvesting a small patch of autologous epithelium adjacent to the melt area with the help of 10% alcohol and transplanting to the site of melt with its basement membrane facing downwards. CG, loaded on the reverse side of Sinskey hook or Weck-Cel sponge, is instilled on this epithelium-melt site complex and withdrawn immediately following which a bandage contact lens is placed on the corneal surface. In our series of patients with nine eyes where EPI-gluing was undertaken, all eyes reported a healed corneal scar with spontaneously dislodged glue and no underlying vascularization at 3-months follow-up. EPI-gluing is an inexpensive and host-friendly technique for the treatment of small noninfectious corneal perforations particularly with iris tissue prolapse.

Tuck-In Tenon Patch Graft in Corneal Perforation.

To describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5-mm size. Thirty-one cases of sterile corneal perforation (3-5 mm) underwent autologous TPG. The technique included, freshening of the edges, measuring the size of defect, creating a 360-degree stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was rate of healing (percentage of cases healed). The mean age was 52.3 ± 8.9 years with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3-5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with formation of a leucomatous scar at 16.9 ± 2.7 weeks, whereas 4 cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for post-op aqueous leak, which healed with the formation of a corneo-iridic scar. TPG is a safe, simple, inexpensive, and an effective technique for the management of corneal perforations. The advantages include the autologous nature of the graft, cost effectiveness, and easy availability.

Microbial Keratitis in Stevens-Johnson Syndrome: A Prospective Study.

To evaluate the microbiological profile and outcome in cases with infective keratitis in Stevens-Johnson syndrome (SJS). Eighty-three eyes of 68 patients with SJS presenting with microbial keratitis were recruited and managed with standard antimicrobial therapy. Microbial keratitis developed in 34% of patients with SJS (83 eyes, 68 patients) over a period of 5 years. Four eyes (4.8%) had a history of concurrent topical steroid use at the onset of keratitis. Mean baseline best-corrected visual acuity was 1.8 ± 0.9 logMAR units. The site of corneal ulceration was central in 52 eyes (62.6%), paracentral in 17 eyes (20.5%), and peripheral in 14 eyes (16.8%). The mean ulcer area was 3.9 ± 2.7 mm. Approximately 15 of 24 (62.5%) culture-positive eyes had bacterial infection, most of which (80%) were caused by Gram-positive bacteria. Polymicrobial infection was noted in 7 of 24 eyes (29.1%). Although 57 of 83 (68.6%) eyes healed with medical therapy, 26 of 83 (31.3%) eyes had corneal perforation and were managed with cyanoacrylate glue application (30.7%) or therapeutic keratoplasty (69.3%). Systemic infection as an inciting factor of SJS and an early presentation for keratitis were the major risk factors associated with corneal perforation. Large mean ulcer size, paracentral ulcers, and punctal involvement were associated with a good visual outcome. Infective keratitis in SJS is common, and unlike routine cases, surgical intervention is often required. However, the antibiotic sensitivity pattern suggests that resistance is not that high.

Treating great and small saphenous vein insufficiency with histoacryl in patients with symptomatic varicose veins and increased risk of surgery.

Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. The immediate success rate of the treatment was 98 %. In follow-up intervals of six weeks, six months, one year, and two years, the anatomical success rates of embolization (recanalization of no more than 5 cm of the junction) were 98, 96, 94, and 94 %, respectively. At identical intervals the venous insufficiency was scored according to the Aberdeen Varicose Vein Questionnaire and the American Venous Clinical Severity Score. In both cases, improvement was demonstrated over the two-year follow-up, with a 0.5 % significance level. Specific clinical signs of venous insufficiency were also evaluated, such as pain, oedema, clearance of varicose veins, and healing of venous ulceration. One severe complication - a pulmonary embolism - was reported, without consequences. We demonstrated that treating insufficient saphenous veins with modified histoacryl application brought a relief from symptoms of venous insufficiency and that the efficiency of this technique is comparable to commonly used methods.

Comparative study between cyanoacrylate tissue adhesive versus skin sutures in closure of wound in 60 operated cases of open inguinal hernia

Background: Today there are numerous methods available for closure of wounds like tissue adhesives, staplers, adhesive tapes and obviously the age old conventional suturing, all of which have their own pros and cons. The aim was to study the complications and results of use of 2-octyl cyanoacrylate on wound healing and compare them without those of conventional suturing.Methods: Study included 60 operated cases of open inguinal hernia. And comparison was made between cyanoacrylate tissue adhesive and conventional skin suturing in open inguinal hernia.Results: 1 out of 30 (3.3%) from tissue adhesive group and 2 out of 30(6.7%) develop fever ( P value=1.000). 4 (13.3%) of tissue adhesive and 4 (13.3%)from suturing developed redness (P value=1.000). 4 (13.3%) tissue adhesive and 5 (16.7%) from suturing had discharge (P value=0.718). 2 (6.7%) and 1 (3.3%) developed wound dehiscence from tissue adhesive and suturing respectively (P value=0.554). 1 (3.3%) from tissue adhesive developed edge eversion (P value=0.313). 24 (80%) wounds are cosmetically good in which tissue adhesive was applied and 2(6.7%) in which suturing was done (P value=0.001) which is statistically significant.Conclusions: Time required for the intraoperative application of cyanoacrylate glue is less than suturing of incision.Incidence of wound infection was found to be less when wound closure done by cyanoacrylate glue in comparison to suturing. A single linear scar was obtained using cyanoacrylate glue which is cosmetically better than suture scar. Incidence of wound dehiscence is more in cases of application of cyanoacrylate glue than suturing.

Getting Hooked: A Simple Technique for the Treatment of Adhesive Injuries to the Eyelids

BackgroundOcular chemical injuries due to accidental exposure or application of cyanoacrylate, commonly known as “superglue,” have increased over the past 30 years. However, current treatment options to relieve eyelid adhesions due to cyanoacrylate applications are difficult to successfully execute and can require sedation or general anesthesia. Here we describe a simple technique to release eyelid adhesions due to cyanoacrylate, or other adhesive agents, that can be successfully performed at bedside without sedation. DiscussionTopical anesthetic is instilled in the involved eye through an opening identified in the lid fissure. A Jameson muscle hook is inserted through the opening with the distal element of the hook normal to the surface of the eye. The hook is then pulled parallel to the lid margins and through the site of adhesion while counter pressure is applied with the fellow hand in the opposite motion of the hook. Residual glue from the eyelashes can be trimmed with blunt-tip scissors. Examination of the eyelids and ocular surface after application of the technique to open the eyelids showed successful release of adhesion sites with no additional injuries to the eye itself. ConclusionsA Jameson muscle hook can be used in emergency departments to safely and successfully relieve eyelid adhesions due to the inadvertent application of cyanoacrylate glue without the use of general anesthesia.

Corneal perforation during laser assisted blepharoplasty

PurposeBlepharoplasty is one of the most commonly performed oculoplastic prodecures. Laser‐assisted blepharoplasty has been performed for several years with some advantages but also it has many complications. We describe two cases of corneal perforation developed during laser assisted blepharoplasty.MethodsTwo patients were referred to our clinic for complaints about decreased visual acuity. They presented with decreased vision, pain and photophobia of their left eye after laser‐assisted blepharoplasty. Both patients had a visual acuity of 20/400 in the affected eye and showed intraocular pressure as low as 5 mmHg. Slit‐lamp examination revealed Seidel‐positive corneal perforation surrounding corneal opacity with corneal folding. The anterior chamber was shallow with mild intraocular inflammation. Application of cyanoacrylate glue to the perforations was done and therapeutic lenses were replaced. Patients were treated with topical antibiotics and artificial tears four times a day.ResultsOne week after the injury, the IOP was elevated within normal range and intact epithelium without leaking was confirmed by slit‐lamp examination. One month later, the visual acuity was regained and subepithelial and stromal corneal opacity was found without inflammation or leaking. And anterior segment optical coherence tomography revealed deep stromal corneal opacity.ConclusionsCorneal perforation during laser blepharoplasty seems probable with eyelid perforation by the laser beam. So during surgery, metal corneal protectors were placed, but corneal perforation could be developed because a Bell's phenomenon with elevation of the cornea superior to the corneal shields. Therefore, to prevent eyelid and corneal perforation, degree of laser power and exposure must be checked carefully.

Tenons Patch Graft in the Management of Large Corneal Perforations.

To describe a technique to manage corneal perforations between 3 and 6 mm in size using autologous Tenons tissue with cyanoacrylate glue and a bandage contact lens. A thin layer of Tenons capsule harvested from the patient's own eye is used to seal the perforation and act as a scaffold. The Tenons patch graft is spread over the perforation and held in place by the application of cyanoacrylate glue. A bandage contact lens is then placed on the eye. A 6-year retrospective review of 28 patients who underwent this procedure was performed. One patient was lost to follow-up. Of the 27 patients who were followed up, 20 healed completely, with an adherent leucoma and preservation of the anterior chamber. The condition of one patient (with a perforated Pseudomonas corneal ulcer) progressively worsened despite maximum medical therapy and had to undergo evisceration. This procedure makes use of easily available autologous Tenons tissue in patients with corneal perforations too large to be managed with cyanoacrylate glue alone, to preserve eyeball morphology. A corneal transplant can then be done when the cornea has healed.

Efficacy of conjunctival resection with cyanoacrylate glue application in preventing recurrences of Mooren's ulcer

AimTo evaluate the role of conjunctival resection along with cyanoacrylate glue and bandage contact lens application in preventing recurrences and arresting progression in cases of Mooren's ulcer.MethodThis retrospective interventional case...

Multidrug-Resistant Pseudomonas aeruginosa Keratitis: Risk Factors, Clinical Characteristics, and Outcomes

To identify risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) keratitis and to report clinical characteristics and outcomes of this infection. Retrospective, case-control study. Ninety episodes of P. aeruginosa keratitis from a tertiary care eye institution from 2007 through 2014 were identified. Episodes of MDR-PA keratitis were taken as cases. Episodes of drug-sensitive P. aeruginosa keratitis during the same period were taken as controls. Chart review of cases and controls. Multidrug resistance was defined as resistance to 3 or more classes of antimicrobial drugs. Logistic regression analysis was used to determine association of baseline characteristics with multidrug resistance. Clinical characteristics and risk factors in each group also were compared. Risk factors for multidrug resistance, including age, gender, eye, duration of symptoms, topical steroid or lubricant ointment use, trauma, prior ocular surgery, presence of a compromised ocular surface, and bandage contact lens use. Twenty-three episodes of MDR-PA keratitis (cases) and 67 episodes of drug-sensitive P. aeruginosa keratitis (controls) were identified. In the multivariate analysis, lubricant ointment use, presence of a compromised ocular surface, and bandage contact lens use were associated with MDR-PA keratitis. Antimicrobial resistance in the MDR-PA keratitis isolates was least for colistin and imipenem (56.52% each). Corneal perforation was more common in cases (52.17% [12 of 23]) than in controls (11.94% [8 of 67]; P = 0.0001). Cyanoacrylate glue application was required in 47.82% of cases (11 of 23), compared with 22.38% of controls (15 of 67; P = 0.031). Keratoplasty was more commonly required in cases (47.82% [11 of 23]) than in controls (20.89% [14 of 67]; P = 0.017). Lubricant ointment use, a compromised ocular surface, and bandage contact lens use are associated with MDR-PA keratitis. Preservative-free lubricant ointment may act as a source or reservoir of infection. Outcomes are worse in MDR-PA keratitis compared with drug-sensitive P. aeruginosa keratitis.

Detectability ofHalyomorpha halys(Hemiptera: Pentatomidae) by Portable Harmonic Radar in Agricultural Landscapes

Abstract Harmonic radar technology enhances capability to track the movement of individual small insects under field conditions. To maximize the capacity of this technology, it is necessary that radar tags must be securely attached to insects and that the tags remain functional when subjected to mechanical stress. In this study, a series of experiments was carried out to test an improved harmonic radar tag designed to be more resistant to mechanical stresses and to establish that a portable harmonic radar system can effectively detect adult Halyomorpha halys Stal (Hemiptera: Pentatomidae) on various structures in different landscapes. The functional resistance of radar tags to ∼1-m free falls on a hard surface was improved significantly by reinforcing the adhesive bond between the radar transponder and the radar wire by application of cyanoacrylate glue. This measure did not affect the detectability of radar tags, and it significantly increased the resistance of radar tags against random mechanical impact...