Comparative Outcomes of Single Versus Multiple Cyanoacrylate Tissue Adhesive Applications in the Management of Corneal Thinning and Perforation.

Abstract

Purpose: To compare outcomes between patients treated with a single cyanoacrylate tissue adhesive (CTA) patch for corneal thinning or perforation and those requiring multiple CTA applications.

Methods: We conducted a single-center, comparative cohort study of patients with corneal thinning or perforation treated with either a single or multiple CTA applications in Toronto, Canada, between 2006 and 2024. Primary outcomes were the need for penetrating keratoplasty (PKP) and the best-corrected visual acuity (BCVA) at final follow-up. Associations between the number of CTA applications with baseline characteristics, perforation characteristics, and final outcomes were analyzed using univariable and multivariable logistic regression models.

Results: Overall, 189 patients (median age 69.0 years; 42% female) were included, with 116 (61%) in the single CTA 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 groups. Central and paracentral corneal defects were more likely to require multiple glue applications than peripheral defects (OR = 2.92, 95% CI, 1.31-6.51, P = 0.009). No difference was observed in final BCVA between groups (median: 2.0 logarithm of the minimum angle of resolution [single] vs. 2.0 logarithm of the minimum angle of resolution [multiple]; P = 0.838). Patients receiving multiple CTA applications (48%, n = 35/73) were more likely to require PKP (OR = 2.70, 95% CI, 1.42-5.15, P = 0.003) than those treated with a single glue patch (26%, n = 30/116).

Conclusions: Multiple CTA applications were more frequently needed for central/paracentral defects and were associated with a greater likelihood of PKP. Given no significant difference in final BCVA, a conservative, stepwise management approach can be pursued without compromising long-term visual outcomes, allowing flexibility in surgical planning.