Actions of Tissue Adhesive

Cyanoacrylate tissue adhesive acts by:

Directly sealing corneal perforations

Providing tectonic support to a weakened cornea

Excluding inflammatory cells from an area of corneal melting

Promoting vascularization

Possible antibacterial action

Indications

Corneal perforations smaller than 1 mm in diameter. (Larger perforations are unlikely to seal with tissue adhesive alone and have a higher risk of inadvertent anterior chamber instillation and subsequent toxicity.)

Sterile corneal ulceration with progressive thinning, descemetocele formation, or frank perforation.

Select infected corneal ulcers with progressive thinning and impending perforation.

Traumatic corneal injuries

Puncture wounds

Small corneal lacerations (< 1 mm)

As an adjunct to corneal suturing in poorly apposed wounds (e.g., stellate wounds)

Small wounds that would otherwise require suture placement in the visual axis.

Preoperative Procedure

1. Perform procedure under slit lamp or operating microscope.

2. Culture the base of corneal thinning or margins of perforation if infection is suspected.

Instrumentation

Lid speculum

Cellulose sponges

Scarifier (e.g., Beaver #57, Grieshaber #681.01)

Capillary tube-type applicator