Authors: Sonia Anchouche, Mona H. Dagher, Laura Segal, Louis Racine, Marie-Claude Robert
Author Disclosure Block: S. Anchouche: None. M. H. Dagher: None. L. Segal: None. L. Racine: Allergan – Consultant. M. Robert: EBSCO – Employee.

Abstract Body:

Purpose: Cyanoacrylate adhesive is routinely used in the treatment of corneal melting and perforations. Despite its widespread use, the literature on its effectiveness remains largely insufficient. The purpose of this study is to examine the outcomes of cyanoacrylate adhesive application in patients with corneal perforation and assess for predictors of treatment response.
Study Design: Retrospective case series.
Methods: A single-center retrospective analysis was conducted for the clinical outcomes of patients over the age of 18 who underwent cyanoacrylate adhesive gluing for corneal perforations between 2013 and 2018. The research protocol was approved by the Centre hospitalier de l'Université de Montréal institutional review board. The primary outcome was the proportion of successful glue applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity, success of subsequent interventions as well as complications after glue application.
Results: 40 patients (40 eyes) were included in this study. The mean age of presentation was 68 ± 13 (58% women) with a median length of follow-up of 317 days ((interquartile range (IQR): 91- 578). The two most common etiologies for corneal perforations were infections (45%; 18/40), and degenerative corneal diseases (18%; 7/40). Thirty percent (12/40) of subjects required more than one application of cyanoacrylate adhesive. Eighteen percent (7/40) of patients experienced a resolution of their corneal perforation with cyanoacrylate gluing alone and 53% (21/40) required subsequent KP. Median duration of cyanoacrylate treatment for patients who did not undergo KP, defined as time between first application of adhesive and first appointment following its dislodgement, was 48 days (IQR: 23 - 85). For the patients requiring KP, the median delay to graft, defined as time between first application of adhesive and date of surgery, was 22 days (IQR: 4 - 49). Of these cases, 67% (14/21) were successful and 33% (7/21) failed. KP success was defined as the presence of a clear graft at last visit. For successful treatment, the median time delay between glue application and KP was 22 days (IQR: 2 - 38). The median time delay for unsuccessful KPs was 27 days (IQR: 13 - 65). There is no significant difference in median time delay between the two categories (p=0.54). Documented complications arising from treatment of corneal perforation with glue included most notably 4 repeat corneal melts and 4 cases of ocular evisceration.
Conclusions: Cyanoacrylate gluing may be considered as a stand alone treatment modality for corneal perforations for some patients. In cases requiring KP, our preliminary data do not reveal any difference in delay to treatment for patients with successful KP and failed KP.