Does underlying etiology of corneal perforation and thinning affect outcomes after glue application?

To evaluate the outcomes of cyanoacrylate tissue adhesive (CTA) in the management of corneal perforation and thinning based on underlying etiology.

This retrospective cohort study included eyes undergoing CTA application for corneal perforation or thinning treated at a tertiary care centre. Eligible cases were categorized into infectious, immune-mediated, ocular surface disease, neurotrophic, or trauma-related etiologies. The primary outcomes were the need for repeat CTA applications and progression to penetrating keratoplasty (PK). Kaplan-Meier survival analysis was conducted to evaluate the time to PK. Multivariable logistic regression was performed to examine associations between etiology and outcomes, adjusting for clinical covariates.

A total of 174 eyes were included (56.9% male, mean age: 66.1 ± 18.7 years). Over a median follow-up of 12.5 months (interquartile range [IQR]: 4.1-20.2), an average of 1.7 ± 0.8 CTA applications were performed per eye, with neurotrophic cases requiring the highest number (2.0 ± 0.8; p = 0.038). Overall, 58 eyes (33.3%) progressed to PK, most commonly in the neurotrophic group (43.5%; p = 0.019). Trauma cases had the most favourable PK-free survival (log rank p = 0.033). In multivariable regression, trauma was associated with lower odds of requiring multiple CTA applications (odds ratio [OR]: 0.22; 95% CI: 0.07-0.70; p = 0.010) and of progressing to PK (OR: 0.19; 95% CI: 0.05-0.74; p = 0.016), whereas neurotrophic cases were associated with increased odds of PK (OR: 1.65; 95% CI: 1.06-3.80; p = 0.031) compared with infectious cases.

Rates of repeat gluing and progression to PK varied by the underlying etiology. Incorporating etiology into prognostication and management decisions may help identify patients at highest risk for early surgical intervention.