Clinical experience with N-butyl cyanoacrylate tissue adhesive in fungal keratitis.
OBJECTIVE
To evaluate the role of tissue adhesive in the management of corneal thinning or perforation associated with active fungal keratitis.


METHODS
Retrospective noncomparative interventional case series.


METHODS
Seventy-three eyes of 73 patients with microbiologically proven keratomycosis associated with thinning or perforation participated in the study. N-Butyl cyanoacrylate tissue adhesive (medical grade) and bandage contact lens were applied in addition to topical and systemic antifungal therapy. Our outcome measures included resolution of the infiltrate and preservation of the structural integrity of the globe.


RESULTS
Outcome data were available for 66 eyes. The infiltrate resolved with scar formation in 42 (63.6%) eyes. In an additional eight (12.1%) eyes, tissue adhesive maintained the structural integrity of the globe while the patients awaited penetrating keratoplasty. Sixteen (24.2%) eyes showed progressive worsening or persistence of the infiltrate after application of tissue adhesive. Twenty-five (37.8%) eyes required multiple applications of tissue adhesive. The outcome was better in cases where the infiltrate measured less than 30 mm2 at the time of presentation and application of tissue adhesive (P < 0.01).


CONCLUSIONS
In view of the poor outcome of penetrating keratoplasty in active fungal keratitis, N-butyl cyanoacrylate tissue adhesive is a useful modality for the management of progressive thinning or perforation associated with active fungal keratitis. However, close observation is mandatory to assess the progression of disease.
Garg
Prashant
P
Cornea Service, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India. prashant@lvpeye.stph.net
Gopinathan
Usha
U
Nutheti
Rishita
R
Rao
Gullapalli N
GN
D000935:Antifungal Agents / Q000627:therapeutic use; D001458:Bandages; D002921:Cicatrix / Q000209:etiology; D003261:Contact Lenses; D003315:Cornea / Q000473:pathology; D004659:Enbucrilate / Q000627:therapeutic use*; D006801:Humans; D007634:Keratitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D009181:Mycoses / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D000935:Antifungal Agents; D014014:Tissue Adhesives; D004659:Enbucrilate