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      Management of a Small Paracentral Corneal Perforation Using Iatrogenic Iris Incarceration and Tissue Adhesive

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          Abstract

          Background

          Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive.

          Case

          A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size) in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body.

          Observations

          The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises.

          Conclusions

          Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.

          Related collections

          Most cited references 6

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          Use of human fibrin glue and amniotic membrane transplant in corneal perforation.

           A Galand,  B Duchesne,  H Tahi (2001)
          To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195-325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high. eal
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            2-Octyl cyanoacrylate medical adhesive in treatment of a corneal perforation.

            To describe a case of successful treatment of a corneal perforation with 2-octyl cyanoacrylate. 2-Octyl cyanoacrylate was applied at the slit lamp with topical proparacaine anesthesia to a cornea with an inferior perforation with iris plugging the defect. After application of 2-octyl cyanoacrylate, the anterior chamber was noted to deepen, and visual acuity improved to 20/200. The glue remained intact for more than 6 weeks and eventually fell out. The underlying cornea healed without scarring, vascularization, or thinning. We have described a case in which 2-octyl cyanoacrylate was used to treat a corneal perforation with excellent results. Further study of this adhesive will be useful in comparing the effectiveness and safety of 2-octyl cyanoacrylate with that of previously studied adhesives.
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              The use of adhesive for the closure of corneal perforations. Report of two cases.

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                Author and article information

                Journal
                Case Report Ophthalmol
                Case Report Ophthalmol
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1663-2699
                May-Aug 2012
                10 July 2012
                10 July 2012
                : 3
                : 2
                : 226-229
                Affiliations
                Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
                Author notes
                *Akira Kobayashi, MD, PhD, Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 (Japan), Tel. +81 76 265 2403, E-Mail kobaya@ 123456kenroku.kanazawa-u.ac.jp
                Article
                cop-0003-0226
                10.1159/000341094
                3398097
                22807912
                Copyright © 2012 by S. Karger AG, Basel

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                Page count
                Figures: 2, References: 5, Pages: 4
                Categories
                Published online: July, 2012

                Ophthalmology & Optometry

                tissue adhesive, corneal perforation, iris incarceration, cyanoacrylate

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