Efficacy of Cyanoacrylate Tissue Adhesive Application in the Management of Corneal Perforations at Preah Ang Duong Hospital in Cambodia

Purpose: The study was to evaluate the efficacy of cyanoacrylate tissue adhesive (CTA) application in corneal perforations. Method: This was a prospective study on 20 patients of corneal perforations who received cyanoacrylate tissue adhesive application as treatment between March 2021 and March 2022 at Preah Ang Duong Hospital. The primary outcome measure was success rate of CTA application, while the secondary outcome was to measure postoperative best-corrected visual acuity (BCVA) and ocular complications. Results: The mean age of patients was 44.15 ± 16.05 years old and 7 (35%) were female. Causes of perforation were microbial infection in 12 patients (60%), trauma in 5 patients (25%), and sterile melting in 3 patients (15%). The perforation of size smaller than 1.5 mm was in 8 patients (40%) while 12 patients (60%) had perforated size between 1.5 mm to 3 mm. The perforation was 60% (12 patients) central, 25% (5 patients) paracentral, and 15% (3 patients) peripherally. Out of 20 patients, 5 patients (25%) received CTA application more than 1 time. The mean glue retention was 57.60 ± 31.84 days. Success rate of glue application (defined as intact globe without surgical intervention regardless of number of CTA applications) was 85%. At the last visit, 7 patients (35%) had BCVA of 6/120 or better. Common complications were uveitis (45%), ocular hypertension (30%), cataract (25%) and neovascularization (20%). No serious complications were found. Conclusion: Cyanoacrylate tissue adhesive is an effective treatment option in sealing corneal perforations with no serious complications. .

Comment on hydration with Cefuroxime-a method for sealing a small leaking corneal perforation

Dear Editor,In a recent interventional case report,Allon et al ）hydrated corneal stroma with cefuroxime to seal a small traumatic leaky corneal perforation that was unresponsive to prior soft bandage contact lens application for 6d.

Distant metastasis in choroidal melanoma with spontaneous corneal perforation and intratumoral calcification: A case report

BACKGROUND Uveal melanoma is the most common primary intraocular malignancy in adults,but its incidence is low in Asian populations.Spontaneous corneal perforation and intratumoral calcification are rare presentations of choroidal melanoma(CM),and reports regarding these presentations have been limited.Even after complete surgical treatment,the prognosis of CM patients is usually poor if distant metastasis is present.We here present a case of CM with unique presentations and early distant metastasis to the liver.CASE SUMMARY A 63-year-old Asian woman presented to our hospital with complaint of pain and brownish discharge from her left eye for 3 d.Imaging studies revealed intratumoral calcification within the left eye with eyeball rupture.Enucleation of the left eye was performed and pathological examination confirmed the diagnosis of CM.Systemic surveillance revealed no metastatic diseases.However,the patient was lost to follow-up 3 mo after surgery.At 1.5 years after the operation,she presented to our emergency department with complaint of dull epigastric pain that radiated to the back for 1 d.Imaging studies revealed a large mass at the upper abdomen abutting the pancreatic neck and body as well as several nodular lesions in the liver.Fine needle biopsy was performed and findings confirmed liver and pancreatic metastases.CONCLUSION This case highlights the importance of continued follow-up of patients with CM.

Fibrin glue-assisted for the treatment of corneal perforations using glycerin-cryopreserved corneal tissue

AIM: To evaluate the outcomes and safety of lamellar keratoplasty(LK) assisted by fibrin glue in corneal perforations. ·METHODS: Six eyes of 6 patients affected by different corneal pathologies(2 posttraumatic corneal scar and 3 bacterial keratitis) underwent LK procedures by using fibrin glue. The mean corneal perforation diameter was 1.35 ±0.64mm(range,0.7-2.5mm),and the greatest diameter of the ulcerative stromal defect was 2.47 ± 0.77mm in average(range,1.5-3.5mm). The donor corneal lamella diameters were 0.20-mm larger and thicker than the recipient to restore a physiologic corneal thickness and shape: mean donor diameter was 8.34 ± 0.28mm(range,8.2-8.7mm) and mean thickness was 352±40.27mm(range,220-400mm). Mean follow-up was 7.33±1.97 months(range,6-11 months). Postoperatively,the graft status,graft clarity,anterior chamber response,the visual prognosis,intraocular pressures,and postoperative complications were recorded. ·RESULTS:Allthecornealperforationsweresuccessfully healed after the procedure. The best-corrected visual acuity(BCVA) ranged from 20/1 000 to 20/50 in their initial presentation,and from 20/100 to 20/20 in their last visit,showed increase in all the patients. No major complications such as graft dislocation and graft failure were noted. Neovascularization developed in the superficial stroma of donor graft in 1 case. High intraocular pressure developed on day 2 after surgery,while was remained in normal range after application of anti-glaucomatous eyedrops for 1 week in 1 case. ·CONCLUSION: Fibrin glue-assisted sutureless LK is valuable for maintaining the ocular integrity in the treatment of corneal perforations.

Corneal Perforation in a Patient with History of Unidentified Urethritis

Purpose: A 40-year-old male with a severe corneal melting, peripheral infiltration and nasal perforation in the right eye after a not affiliated case of urethritis is reported. Methods: Retrospective case report. Results: A sample of conjunctival discharge was sent to culture, in where Gram-diplococci grew and therefore a systemic antibiotic treatment was initiated. Given the severity of the clinic, a penetrating keratoplasty is conducted two days after admission and the corneal button was sent to microbiology, which polymerase chain reaction was positive for Neisseria gonorrhoeae. Conclusion: Despite it being a rare process in an adult, keratitis caused by Neisseria gonorrhoeae should be suspected in all sexually active patients with conjunctivitis and with a clinic genitourinary medical history. The systemic therapy showed a superior effectiveness in combination with topical therapy than the last one on its own.

An Unusual Presentation of Corneal Perforation in a Neonate Following Instrument-Assisted Delivery

A 25-week-old neonate was noted to have unilateral corneal edema and buphthalmos at birth following a forceps assisted delivery. Ten days later, examination of the neonate under anesthesia showed a central corneal perforation with a possible retinal detachment. By this time the neonate’s affected eye was deemed unsalvageable, and therefore an enucleation was performed with insertion of an ocular implant. Subsequent histopathology of the enucleated eye revealed a grossly malformed anterior segment and findings usually associated with congenital glaucoma. This is the first reported case in the literature of a neonatal corneal perforation in the context of instrument-assisted delivery. This case highlights the need to actively investigate the aetiology of cloudy corneas in neonates. Early exploration and surgical intervention may be necessary especially if congenital glaucoma is suspected to be the underlying aeitlogy.

Repair of Spontaneous Corneal Perforation in Pellucid Marginal Degeneration Using Amniotic Membrane

A 47-year-old woman with a history of pellucid marginal degeneration was referred for management of hydrops and peripheral perforation of the right cornea. The initial management with cyanoacrylate tissue adhesive and bandage contact lens did not preclude aqueous leakage the next day. Amniotic membrane grafting using both a surgical graft and a bandage patch was thus performed in the operating room the following day. There was no aqueous leakage on the first post-operative day. The corneal integrity was restored with resolution of the corneal edema;and the visual acuity improved from 20/400 before surgery to 20/40 three months later. This case illustrates the clinical efficacy of amniotic membrane grafting as an effective alternative in the management of spontaneous corneal perforation resulted from pellucid marginal degeneration.

Corneal perforation and rare primary adenocarcinoma of the lacrimal gland: A case report

Rationale:Primary adenocarcinoma of the lacrimal gland is rare,and its presentation as corneal perforation is even rarer.Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery,yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management.Patient's concerns:A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball.Uveal tissue was prolapsing over the perforated keratitis cornea,and the eye was full of discharge.Diagnosis:Bedside ultrasound B-scan confirmed vitreous haze,and emergency contrast computed tomography(CT)revealed soft tissue density mass(>40 mm)molding around the left globe and optic nerve without any rim enhancing abscess.Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed.Interventions:Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading.Orbital walls were biopsied intra-operatively,and tumor staging was completed by positron emission tomography-CT scan and magnetic resonance imaging.Without evidence of metastasis,left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin.Outcomes:Left exenterated orbit was fully epithelialized at around 2 months,and there was no recurrence of the disease up to present at the 1 year follow-up.Lessons:Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority,yet it may not always be possible as in our case presenting with corneal perforation.

Allogeneic sclera graft combined autologous conjunctival flap for repairing the emergent corneal perforation

To report a palliative and alternative surgical procedure, allogeneic sclera graft combined with autologous conjunctival flap (ASGACF), employing to repair the large emergent corneal perforation. The detail protocol of the surgical procedure was characterized and four representative cases were reviewed. An allogeneic sclera graft and recipient bed were prepared as the traditional penetrating keratoplasty (PK). And then sutured the sclera graft to the bed with 10-0 nylon suture and covered with a pedicled autologous conjunctival flap in half size. In the follow-up, the ASGACF repaired all of the corneal perforations and restored the integral walls of eyeballs, in spite of one who underwent a second surgery. This surgical procedure provided a palliative method to repair the large emergent corneal perforation while there is the lack of a corneal graft.

A Novel Tectonic Keratoplasty with Femtosecond Laser ntrastromal Lenticule for Corneal Ulcer and Perforation

Background： Small incision refractive lenticule extraction （SMILE） is an effective laser procedure that treats myopia. This research was to describe a novel approach to treat corneal ulcer or perforation using the corneal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule （TEKIL）. Methods： A total of twenty patients （22 eyes） were monitored for at least 6 months and were assessed using slit lamp microscopy, optical coherence tomography, and best-corrected visual acuity （BCVA）. Postoperative complications throughout the study period were recorded. Results： Corneal ulcer in 14 patients （16 eyes） and corneal perforation in six patients （6 eyes） were treated with TEKIL. The patients were ten females and ten males, with a mean age of 58.5 ± 16.3 years （range： 16 81 years）. In this study, the most causes of corneal ulcer or perforation were immunologic causes （54.5%）. After TEKIL procedure, global integrity was achieved in all cases. No immune rejection or perforation was detected. The mean BCVA improved from 0.17± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up （t = 2.095, P 0.052）. The postoperative BCVA improved in 12 eyes （54.5%） and maintained in nine eyes （40.9%）. Vision function successfully maintained in all eyes （100%）. In three cases, corneal ulcers were treated by reoperation of TEKIL at 3 months alter the initial surgery for the reason that the residual corneal thickness was 〈250 μm. Conclusions： TEKI L seems to be an effective treatment for corneal ulcer and perforation in the condition of emergency and donor shortage.

Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering

AIM： To investigate cap morphology after small-incision lenticule extraction （SMILE） and its effects on intraocular scattering. METHODS： Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at ld, lwk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System （OQAS） values, and objective scattering index （OSI）, were evaluated using OQASTM. RESULTS： Cap thickness decreased from ld to lwk （P〈0.001）, but remained higher than intended thickness of 120 μm after 3mo （P〈0.001）. Cap thickness in central area was thinner than that of in the paracentral and peripheral areas （P〈0.0001）. Total number of microdistortions decreased from ld to 3mo （P〈0.0001）. Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at ld and lmo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at ld and lmoafter surgery. CONCLUSION： The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.

Rapid corneal thinning and perforated ulcerative keratitis in a patient with relapsing polychondritis

Background:To report rapid corneal thinning and perforation in a case with relapsing polychondritis.Case presentation:A 43 year-old male diagnosed with relapsing polychondritis suffered from bilateral scleritis,bilateral swelling of pinna,saddle nose and tracheal stenosis.The patient presented with right eye pain and redness for one month.Slit lamp examination of the right eye showed 80%peripheral corneal thinning between 3 and 7 o’clock.The best-corrected visual acuity(BCVA)was 1.0 bilaterally.The degree of corneal thinning worsened to 90%after one week of oral corticosteroid use.Subsequently,topical cyclosporine 2%eye drops four times a day,oral doxycycline 100 mg twice a day and oral vitamin C 2 g daily were added.The corneal thinning gradually improved to about 60%.However,the patient rapidly tapered oral prednisolone against medical advice and returned with an acute drop in vision in his right eye.Slit lamp examination of the right eye showed peripheral corneal perforation with iris prolapse.An emergency repair with cyanoacrylate glue was performed.Intravenous methylprednisolone 1 mg/kg body weight was administered for three days and 1 g/day intravenous immunoglobulin was administered every four weeks.At 3 months postoperatively,BCVA in the right eye was 0.6.Slit lamp examination showed a well-formed anterior chamber with glue in situ.Conclusions:Relapsing polychondritis may be associated with rapid corneal thinning.The clinicians should be aware of the possibility of corneal perforation in these cases.Cyanoacrylate glue is a viable temporary management option in such scenarios.

Management of coronary artery perforation by embolization:nursing experience from 3 cases

INTRODUCTION With the development of economy and improvement of life quality,the incidences of hypertension,hyper-cholesterolemia,diabetes,obesity and smoking have been increased in China,which has led to a significant increase in the morbidity and mortality of coronary artery disease（CAD）~1.Since it was introduced into China in 1984,coronary intervention（PCI）has developed rapidly and has become the major treatment of CAD because of its unique characteristics of minimal invasive and effective outcome.

Applications of SMILE-extracted lenticules in ophthalmology

AIM:To review recent innovations,challenges,and applications of small incision lenticule extraction(SMILE)extracted lenticule for treating ocular disorders.METHODS:A literature review was performed in the PubMed database,which was last updated on 30 December 2021.There was no limit regarding language.The authors evaluated the reference lists of the collected papers to find any relevant research.RESULTS:Due to the simplicity and accuracy of modern femtosecond lasers and the extensive development of SMILE surgery,many healthy human corneal stromal lenticules were extracted during surgery,motivating some professionals to investigate the SMILE lenticule reusability in different ocular disorders.In addition,new approaches had been developed to preserve,modify,and bioengineer the corneal stroma,leading to the optimal use of discarded byproducts such as lenticules from SMILE surgery.The lenticules can be effectively re-implanted into the autologous or allogenic corneas of human subjects to treat refractive errors,corneal ectasia,and corneal perforation and serve as a patch graft for glaucoma drainage devices with better cosmetic outcomes.CONCLUSION:SMILE-extracted lenticules could be a viable alternative to human donor corneal tissue.

SMILE不同角膜帽厚度对近视散光患者术后散光及早期视觉质量的影响

目的:比较飞秒激光小切口角膜基质透镜取出术(SMILE)中不同眼角膜帽厚度对近视散光患者术后散光及早期视觉质量的影响。方法:采用前瞻性对照研究,选取我院2020-06/2022-06接受SMILE手术的近视散光患者54例108眼,根据随机数字表法分为A组、B组(各27例54眼),A组、B组角膜帽厚度设计分别为110、120μm,其余手术参数一致。比较两组患者术前及术后1 d,1 wk,1 mo的裸眼视力(UCVA)、等效球镜度(SE)、角膜硬度参数(SP-A1)、视觉质量和散光矢量分析结果等。结果:两组患者手术前后各时间点的UCVA、SE、SP-A1有时间差异(均P<0.05),术后1 d A组UCVA优于B组(P<0.05)。两组患者的散光矢量分析结果比较无差异(均P>0.05)。术后1 d A组的客观散射指数(OSI)低于B组,斯特列尔比(SR)高于B组(均P<0.05)。两组间术后调制传递函数截止频率(MTF cut off)、对比度视力、视觉症状及总体满意度、并发症发生率比较无差异(均P>0.05)。结论:110μm或120μm的角膜帽厚度在SMILE矫正近视散光方面均是安全有效的,且不影响术后的SE、散光、SP-A1以及对比度视力。110μm角膜帽厚度术后早期视力恢复更快且早期视觉质量优于120μm。

SMILE来源的角膜基质透镜临床再利用的研究进展

随着飞秒激光小切口角膜基质透镜取出术(SMILE)的普及,术中大量一片式角膜基质透镜被取出。角膜基质透镜作为手术的额外产物,对其进行基础研究及临床再利用已成为近年来的研究热点。角膜基质透镜薄而透明,来源丰富,成本低廉,具有低免疫源性及良好的组织相容性等优点,是研究细胞和角膜基质的重要来源,也可作为临床上角膜加固、补片移植、屈光矫正及泪道栓塞的良好生物材料。文章就SMILE手术来源的角膜基质透镜在治疗角膜相关疾病,矫治远视及老视,覆盖青光眼引流阀防止其暴露及用于泪道栓等方面的应用进行综述,旨在充分认识其在临床上的再利用,扩大其手术应用范围,为其他眼病的治疗及组织器官中的应用提供新方向。

角膜基质透镜在角膜溃疡或穿孔修复中的应用

目的:研究由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植材料治疗角膜溃疡的临床疗效。方法:回顾性病例研究。收集本院2017-01/06角膜溃疡患者6例6眼,其中细菌性、真菌性、深层异物伴感染各1例1眼,角膜穿孔3例3眼。采用由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植的材料进行修复手术,确保植片与角膜层间无空气间隙。术后随访1~6(平均3.71±1.56)mo,观察手术前后视力、角膜移植物存活情况及术后并发症发生情况等。结果:所有患者均在控制感染下顺利完成手术,无术中并发症。术后所有角膜植片透明。末次随访时,患者最佳矫正视力(best corrected visual acuity,BCVA)较术前明显改善(0.48±0.12 vs 1.50±0.08),差异具有统计学意义(P<0.01)。结论:来源于全飞秒激光屈光手术的角膜基质透镜用于角膜溃疡修复是安全有效的,但植片的远期疗效尚需进一步观察。

羊膜填塞联合前房C_3F_8注气术治疗外伤性角膜穿孔

目的:探讨羊膜填塞联合前房C3F8注气术治疗外伤性角膜缺损并穿孔的疗效。方法:应用甘油冷冻保存羊膜制作成羊膜卷,对5例外伤性角膜缺损并穿孔患者行羊膜填塞联合前房C3F8注气术治疗。结果:术后前房形成好,羊膜卷无脱出或脱入前房,角膜缺损逐渐愈合。视力均得到提高,术前视力均小于0.1,术后3mo时,有3例视力>0.5,1例0.3,1例0.08。结论:羊膜填塞联合前房C3F8注气术治疗外伤性角膜缺损并穿孔是一种简便易行,疗效较好的治疗方法。

多层羊膜覆盖治疗角膜穿通伤的临床研究

目的:探讨多层羊膜覆盖治疗角膜穿通伤的疗效,为角膜穿通伤患者提供一种新的治疗方法。方法:对20例20眼外伤性角膜缺损并穿孔的患者采用多层羊膜覆盖,术后随访3～6mo,观察前房形成,羊膜持续时间,术后视力变化等。结果:患者20例术后第1d前房均形成。术后1mo穿孔愈合,角膜修补处呈半透明状混浊,未见新生血管长入,术后本组病例的视力均无提高。结论:多层羊膜覆盖是治疗角膜穿通伤有效、安全的方法,它能维持眼球结构的完整,减轻了炎症反应,为后续的穿透性角膜移植创造了良好的条件。

羊膜移植联合结膜瓣遮盖治疗小儿细菌性角膜溃疡穿孔的研究

目的:探讨羊膜移植联合结膜瓣遮盖治疗小儿细菌性角膜溃疡穿孔的可行性。方法:采用新鲜羊膜移植联合结膜瓣遮盖治疗小儿细菌性角膜溃疡穿孔5例(5眼),术后随访6～24mo。结果:全部患眼治愈,未见复发。术后均未见新鲜羊膜移植片急性排斥反应,炎症控制。4～5wk角膜上皮愈合,2眼视力不同程度提高。结论:羊膜移植联合结膜瓣遮盖是治疗小儿细菌性角膜溃疡穿孔的有效方法。