Comparative Outcomes of Single vs. Multiple Cyanoacrylate Tissue Adhesive Applications in the Management of Corneal Thinning and Perforations - 5160
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Author’s Disclosure Block: Ryan Huang: none; Manokamna Agarwal: none; Michael Mimouni: Consultant – Lapidot Medical, Lumenis, EyeYon Medical, Orasis Pharmaceuticals, Precise Bio, Amntiotek, Labtician. ; Clara Chan: Consultant – Aequus, Abbvie, Admare Bioinnovations, Allergan Inc., Aurion, Bausch & Lomb, Johnson & Johnson Vision, Kala Ophthalmics, Labtician Ophthalmics Inc., Novartis, Santen Inc., Sun Ophthalmics, Thea, Valeo Pharma. Financial support (to institution) – Aurion, Corneat, Claris Bio. Lecture fees – Abbvie, Allergan Inc., Johnson & Johnson Vision, Labtician Ophthalmics Inc., Thea
Abstract Body
Purpose: Cyanoacrylate glue is commonly used to treat corneal thinning and perforations; however, some cases necessitate multiple applications due to persistent leakage, displaced glue, or progressive thinning. This study aims tocompare outcomes between patients treated with a single cyanoacrylate tissue adhesive (CTA) patch for corneal thinning or perforations and those requiring multiple CTA applications. Study Design: Single-center, retrospective review of medical records from patients with corneal thinning and perforations treated by two corneal specialists in Toronto, Canada, from 2006 to 2024. Methods: Eligible patients were treated with at least one CTA patch for thinning or perforation during the follow-up period. The primary outcomes were the need for tectonic penetrating keratoplasty (PKP) and final best corrected visual acuity (BCVA). Associations between the number of CTA applications and baseline characteristics (age, sex, initial BCVA), perforation characteristics (underlying cause, location, and area), and final outcomes were analyzed using univariable and multivariable logistic regression models, adjusted for age, sex, underlying cause, and location on Stata 17.0. Results: Overall, 189 patients (median age 69.0 years; 42% female) were included, with 116 (61%) in the single CTA application group and 73 (39%) in the multiple application group (mean 2.3 ± 0.6), over a median follow-up of 4.4 months. Baseline characteristics were similar between the two groups. Central and paracentral perforations were more likely to require multiple CTA applications compared to peripheral perforations (OR=2.92, 95%CI=[1.31-6.51], p=0.009). No difference was observed in final BCVA between groups (median: 2.0 logMAR [single] vs. 2.0 logMAR [multiple]; p=0.838). Patients receiving multiple CTA applications (47%, n=34/73) were more likely to require PKP (OR=2.70, 95%CI=1.42-5.15, p=0.003) compared to those treated with a single glue patch (26%, n=30/116). Conclusions: Multiple glueapplicationswere more frequently required in patients with central or paracentral perforations and were associated with a greater likelihood of needing a tectonic PKP.Given that there wasno significant difference infinalBCVA betweengroups, these findings suggest that a conservative, stepwise approach to management can be pursued without compromising long-term visual outcomes, allowing flexibility in surgical planning.