title: Clinical experience with N-butyl cyanoacrylate tissue adhesive in fungal keratitis.
abstract: 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.
authors.affiliation: Cornea Service, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India. prashant@lvpeye.stph.net
authors.forename: Prashant
authors.initials: P
authors.lastname: Garg
authors.forename: Usha
authors.initials: U
authors.lastname: Gopinathan
authors.forename: Rishita
authors.initials: R
authors.lastname: Nutheti
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D014014:Tissue Adhesives; D004659:Enbucrilate