The Efficacy of N-Butyl-2 Cyanoacrylate (Histoacryl) for Sealing Corneal Perforation: A Clinical Case Series and Review of the Literature

Abstract

Purpose: To investigate the efficacy of corneal gluing procedures for corneal perforations of mixed aetiologies in a tertiary eye hospital in Sydney, Australia. Design: Retrospective case series. Methods: Episodes of corneal gluing procedures were identified from the Sydney Eye Hospital surgical database over 42 months from January 2010. All gluing procedures in this study were conducted in the operating theatre. Categorical variables were compared using Pearson's chi-square test. Results: Forty-five episodes of corneal gluing using n-butyl-2-cyanoacrylate were identified from 30 eyes. 18 eyes were glued once, 9 eyes were glued twice and 3 eyes were glued thrice. The median duration of butyl-cyanoacrylate adhesion was 14 days, range 1 to 1945 days. Our data yielded an episodic success rate of 67% for n-butyl-2-cyanoacrylate gluing when success was defined as the tissue adhesive sealing the leak until healing by scarring or until planned definitive surgery. Secondary outcomes included success rate by the location, aetiology, and size of the corneal perforation, and did not reach statistical significance. Of our 30 eyes treated with n-butyl-2cyanoacrylate glue, 47% (n=14) did not require further surgical intervention and healed by scarring. The complications noted with n-butyl-2-cyanoacrylate use were cornea vascularisation (n=5), conjunctival and corneal irritation (n=2), and secondary microbial keratitis (n=1). Conclusions: Corneal gluing using n-butyl-2-cyanoacrylate was successful in 67% of episodes. Almost half of our eyes healed without surgical intervention. Corneal gluing, previously thought to be a temporising measure, is effective and can potentially be a definitive treatment.