Clinical Ophthalmology (Jan 2023)
Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions
Abstract
Ashok Sharma,1 Namrata Sharma,2 Sayan Basu,3 Rajan Sharma,1 Shruti Aggarwal,4 Parul Chawla Gupta,5 Jagat Ram,6 Verinder S Nirankari7 1Dr Ashok Sharma Cornea Centre, Chandigarh, UT, India; 2Cornea Service, Dr. R. P. Centre, AIIMS, New Delhi, India; 3LVPEI Banjara Hills, Hyderabad, Telangana, India; 4Anterior Segment Cataract Surgery, Katzen Eye Group, Baltimore, MD, USA; 5Advanced Eye Centre, PGIMER, Chandigarh, UT, India; 6Advanced Eye Centre PGIMER, Chandigarh, UT, India; 7University of Maryland, Baltimore, MD, USACorrespondence: Ashok Sharma, SCO 2463-2464, Sector 22C, Cornea Service, Dr Ashok Sharma’s Cornea Centre, Chandigarh, 160022, India, Email [email protected]: Corneal perforations are ophthalmological emergencies which can have serious and detrimental consequences, if not managed timely and appropriately. These are a significant cause of ocular morbidity and can result in decreased vision, blindness, and even loss of the eye. Corneal perforations can be managed using a range of treatment approaches, including temporary solutions such as the application of corneal glue and bandage contact lens, as well as definitive treatment such as corneal transplantation. Tissue glues/adhesives were developed as substitutes for sutures in ophthalmic surgery. Unlike sutures, these glues are associated with shorter overall surgical times and reduced inflammation, thus improving postoperative comfort without compromising wound strength. The available tissue adhesives can be broadly classified into two types: synthetic (eg, cyanoacrylate derivatives) and biological (eg, fibrin glue). Cyanoacrylate glue is chiefly used as a corneal patch to manage acute corneal perforations and improve visual outcomes. Fibrin glue can be used instead of cyanoacrylate glue in many conditions with the benefits of reduced conjunctival and corneal inflammation and reaction. Apart from this, each type of adhesive is distinct in terms of its benefits as well as limitations and is accordingly used for different indications. The present review focuses on the two main types of tissue adhesives, their applications in the management of corneal perforations, the associated complications, safety and efficacy data related to their use available in the literature and the need for newer adhesives in this field.Keywords: corneal perforation, tissue adhesives, cyanoacrylate, fibrin glue, corneal patch
