Clinical Outcomes and Predictive Factors for Penetrating Keratoplasty Following Glue Application for Corneal Perforation and Thinning

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-08-18 DOI:10.1016/j.ajo.2025.08.030

Manokamna Agarwal , Ryan S Huang , Michael Mimouni , David S Rootman , Clara C Chan

{"title":"Clinical Outcomes and Predictive Factors for Penetrating Keratoplasty Following Glue Application for Corneal Perforation and Thinning","authors":"Manokamna Agarwal , Ryan S Huang , Michael Mimouni , David S Rootman , Clara C Chan","doi":"10.1016/j.ajo.2025.08.030","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the clinical outcomes and identify predictive factors associated with the need for penetrating keratoplasty (PKP) following cyanoacrylate tissue adhesive (CTA) application for corneal perforation or thinning.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study.</div></div><div><h3>Methods</h3><div>We conducted a single-center, retrospective cohort study of 189 eyes treated with CTA for corneal thinning or perforation between January 2006 and August 2024 at a tertiary care center. The primary outcome was the best-corrected visual acuity (BCVA) at final follow-up. Univariable and multivariable logistic regression models were used to identify associations between baseline and clinical characteristics with progression to PKP following CTA management.</div></div><div><h3>Results</h3><div>Of 189 eyes treated with CTA, 64 (34%) underwent subsequent PKP after CTA application. Multivariable regression identified several independent predictors of needing PKP, including central or paracentral defect location (vs peripheral, OR = 2.98, 95% CI = 1.27-6.91, <em>P</em> = .012), multiple CTA applications (vs single, OR = 2.70, 95% CI = 1.42-5.15, <em>P</em> = .003), worse baseline BCVA (logMAR >2 vs logMAR <1; OR = 3.10, 95% CI = 1.35-6.58, <em>P</em> = .005), and viral keratitis (OR = 3.55, 95% CI = 1.21-9.58, <em>P</em> = .020). Trauma was associated with lower odds of PKP (OR = 0.26, 95% CI = 0.08-0.80, <em>P</em> = .014). Median final BCVA following PKP was 2.0 logMAR (IQR: 1.5-2.3), with no significant difference from baseline (<em>P</em> = .585).</div></div><div><h3>Conclusion</h3><div>PKP remains an important intervention for eyes refractory to CTA; however, final visual outcomes are limited. Early identification of high-risk clinical features may help guide timely decision-making and set realistic expectations regarding prognosis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 203-208"},"PeriodicalIF":4.2000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002939425004386","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

To describe the clinical outcomes and identify predictive factors associated with the need for penetrating keratoplasty (PKP) following cyanoacrylate tissue adhesive (CTA) application for corneal perforation or thinning.

Design

Retrospective clinical cohort study.

Methods

We conducted a single-center, retrospective cohort study of 189 eyes treated with CTA for corneal thinning or perforation between January 2006 and August 2024 at a tertiary care center. The primary outcome was the best-corrected visual acuity (BCVA) at final follow-up. Univariable and multivariable logistic regression models were used to identify associations between baseline and clinical characteristics with progression to PKP following CTA management.

Results

Of 189 eyes treated with CTA, 64 (34%) underwent subsequent PKP after CTA application. Multivariable regression identified several independent predictors of needing PKP, including central or paracentral defect location (vs peripheral, OR = 2.98, 95% CI = 1.27-6.91, P = .012), multiple CTA applications (vs single, OR = 2.70, 95% CI = 1.42-5.15, P = .003), worse baseline BCVA (logMAR >2 vs logMAR <1; OR = 3.10, 95% CI = 1.35-6.58, P = .005), and viral keratitis (OR = 3.55, 95% CI = 1.21-9.58, P = .020). Trauma was associated with lower odds of PKP (OR = 0.26, 95% CI = 0.08-0.80, P = .014). Median final BCVA following PKP was 2.0 logMAR (IQR: 1.5-2.3), with no significant difference from baseline (P = .585).

Conclusion

PKP remains an important intervention for eyes refractory to CTA; however, final visual outcomes are limited. Early identification of high-risk clinical features may help guide timely decision-making and set realistic expectations regarding prognosis.

查看原文本刊更多论文

应用胶水治疗角膜穿孔和薄化后穿透性角膜移植术的临床结果和预测因素。

目的：描述应用氰基丙烯酸酯组织粘接剂（CTA）治疗角膜穿孔或变薄后需要穿透性角膜移植术（PKP）的临床结果和预测因素。设计：回顾性临床队列研究。方法：我们进行了一项单中心、回顾性队列研究，对2006年1月至2024年8月在三级保健中心接受CTA治疗角膜变薄或穿孔的189只眼睛进行了研究。主要终点为最终随访时的最佳矫正视力（BCVA）。单变量和多变量logistic回归模型用于确定基线和临床特征与CTA治疗后PKP进展之间的关系。结果：189只接受CTA治疗的眼睛中，64只（34%）在CTA应用后进行了PKP。多变量回归确定了需要PKP的几个独立预测因素，包括中心或中心旁缺陷位置（相对于周围，or =2.98, 95%CI=1.27-6.91， P=0.012），多种CTA应用（相对于单一，or =2.70, 95%CI=1.42-5.15， P=0.003），更差的基线BCVA (logMAR bbbb2 vs logMAR结论：PKP仍然是对CTA难治性眼睛的重要干预措施，然而，最终的视觉结果是有限的。早期识别高危临床特征有助于指导及时决策，并对预后设定切合实际的期望。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.