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Infectious keratitis and cyanoacrylate adhesive
1Cornea Service, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract:
We studied three patients with infectious keratitis that occurred after cyanoacrylate gluing despite prophylactic antibiotic therapy. Two patients developed culture-positive bacterial ulcers, one caused by a methicillin-resistant Staphylococcus aureus and the other by Haemophilus influenzae. The third patient developed a fungal keratitis. Two patients required penetrating keratoplasty. Each infection and perforation was concealed by the opaqueness of the glue. The pain of the infectious ulcers may have been obscured by the ocular surface irritation and drying induced by glue. Tissue toxicity, microbial colonization, use of bandage lenses, and long-term broad-spectrum antibiotics may precipitate glue-related corneal infections. Masking of underlying infection and the development of resistant organisms should be considered when using this mode of therapy.
Insights
Cyanoacrylate glue for infectious keratitis can mask serious infections, leading to complications like bacterial or fungal ulcers and the need for corneal transplants. Careful consideration of risks is essential.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Corneal Surgery
Background:
- Cyanoacrylate glue is used in ophthalmology, but its potential complications are not fully understood.
- Infectious keratitis is a serious condition that can lead to vision loss.
- Prophylactic antibiotic therapy may not always prevent infections associated with ocular procedures.
Observation:
- Three cases of infectious keratitis after cyanoacrylate gluing are presented.
- Two cases involved bacterial ulcers (MRSA, H. influenzae), one fungal.
- Opaqueness of glue masked infection and perforation; pain was possibly obscured.
Findings:
- Infections occurred despite prophylactic antibiotics.
- Two patients required penetrating keratoplasty.
- Glue-related corneal infections can be severe and sight-threatening.
Implications:
- Consider tissue toxicity, microbial colonization, bandage lenses, and long-term antibiotics as risk factors.
- Masking of infection and development of resistant organisms are key concerns.
- Careful patient selection and monitoring are crucial when using cyanoacrylate adhesives.