Cornea Cases

Title:

A simple and effective gluing technique for corneal perforations : The use of dried amniotic membrane with Histoacryl®

Case Report Details

First Author: D.Baba UK

Co Author(s):    M. Ahmad   L. Pagano   V. Romano   S. Kaye           

Abstract Details

Purpose:

To describe a novel gluing technique using pre-cut dried amniotic membrane along with Histoacryl® glue in management of corneal perforations.

Setting:

The Ophthalmology department at The Royal Liverpool University Hospital, Liverpool, UK.

Report of case or case series:

A patient attended the Emergency Eye Clinic with a right corneal perforation partially plugged by the iris following a infectious keratitis. Corneal gluing was performed in theatre using a 5 mm disc of clear sterile drape. The glue dislodged 3 days later at which point the cornea was re-glued. The second corneal glue lasted for another 3 days before being dislodged again. The patient was taken back to theatre for his 3rd gluing attempt. This time the gluing was performed in combination with a dry amniotic membrane. After drying the corneal surface with a spear, a drop of Histoacryl® glue was applied followed by immediate application of a dried amniotic membrane. The glue was allowed to set for a few minutes, following which a bandage contact lens was inserted. The patient was then followed up as an outpatient for several weeks. The glue and the amniotic membrane remained in position and the globe formed throughout the follow-up period. The glue was removed approximately 3 months after application. There was no leak and an anterior segment OCT confirmed healing of the corneal wound with a corneal thickness of 460um.

Conclusions/Take Home Message:

Dried amniotic membranes are malleable and can adapt to the contour of the underlying glue. This provides a smoother surface and could thereby increase durability and reduce need for re-gluing. A variation of the technique could be utilised in cases of corneal perforation with iris incarceration. A small 2 mm disc of the dry amniotic membrane could be centred directly over the perforation, followed by application of glue. This can be followed by application of a larger, pre-cut disc of dry amniotic membrane to cover the glue. This can potentially prevent the glue attaching to the iris that may be incarcerated in the wound and aid formation of the anterior chamber. The use of dried amniotic membrane along with Histoacryl® is a simple and effective method for management of acute corneal perforations. This technique is simple enough to be done by a general ophthalmologist in clinic settings.