Management of a Small Paracentral Corneal Perforation Using Iatrogenic Iris Incarceration and Tissue Adhesive

Abstract

Background: Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive. Case: A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size) in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body. Observations: The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises. Conclusions: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.

Corneal Perforation Self-Healing with an Iris Plug in the Cornea

“…The iris plug is a mechanical closure for corneal ulcer and secures the anterior globe structure. Kobayashi et al [6] presented a 2-week follow-up of iris incarceration as an additional procedure to surgical management of corneal ulcers. After manipulation the patient showed good visual outcome as a result of minimal residual scaring and related astigmatism.…”

Corneal Perforation Self-Healing with an Iris Plug in the Cornea

“…The iris plug is a mechanical closure for corneal ulcer and secures the anterior globe structure. Kobayashi et al [6] presented a 2-week follow-up of iris incarceration as an additional procedure to surgical management of corneal ulcers. After manipulation the patient showed good visual outcome as a result of minimal residual scaring and related astigmatism.…”

Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer

“…A key in the surgical management is to patch the perforated hole first. The autologous iris,16 conjunctival flap,17 sclera,18 and reversed autologous corneal flap19 can be used to seal small perforated holes, but these materials may induce iris anterior synechiae, leakage at the graft–host interface for lack of endothelial cells, or poor looks. For the large perforation, they seem to be ineffective.…”

Adhesive bioactive materials in ocular applications: Toward smart, regenerative, and minimally invasive therapies

“…CTAs are primarily composed of alkyl cyanoacrylate monomers, which are esters of α-cyanoacrylic acid synthesized through the condensation of cyanoacetic acid esters and formaldehyde [ 12 ]. In ophthalmic surgery, CTAs serve as alternatives to sutures and are applied in various contexts, such as cataract incision repair [ 141 ], retinal detachment management [ 142 ], scleral reinforcement [ 143 ], extraocular muscle attachment [ 144 ], and corneal perforation closure [ 145 ]. Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation.…”

“…Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation. As a synthetic bioactive adhesive material for ocular applications, CTA exhibits one of the highest mechanical strengths among its class [ 77 ], a characteristic well-supported by extensive clinical studies [ 8 , 9 , 14 , 15 , [145] , [146] , [147] ].…”

Corneal Perforation Self-Healing with an Iris Plug in the Cornea

“…The iris plug is a mechanical closure for corneal ulcer and secures the anterior globe structure. Kobayashi et al [6] presented a 2-week follow-up of iris incarceration as an additional procedure to surgical management of corneal ulcers. After manipulation the patient showed good visual outcome as a result of minimal residual scaring and related astigmatism.…”

Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer

“…A key in the surgical management is to patch the perforated hole first. The autologous iris,16 conjunctival flap,17 sclera,18 and reversed autologous corneal flap19 can be used to seal small perforated holes, but these materials may induce iris anterior synechiae, leakage at the graft–host interface for lack of endothelial cells, or poor looks. For the large perforation, they seem to be ineffective.…”

Adhesive bioactive materials in ocular applications: Toward smart, regenerative, and minimally invasive therapies

“…CTAs are primarily composed of alkyl cyanoacrylate monomers, which are esters of α-cyanoacrylic acid synthesized through the condensation of cyanoacetic acid esters and formaldehyde [ 12 ]. In ophthalmic surgery, CTAs serve as alternatives to sutures and are applied in various contexts, such as cataract incision repair [ 141 ], retinal detachment management [ 142 ], scleral reinforcement [ 143 ], extraocular muscle attachment [ 144 ], and corneal perforation closure [ 145 ]. Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation.…”

“…Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation. As a synthetic bioactive adhesive material for ocular applications, CTA exhibits one of the highest mechanical strengths among its class [ 77 ], a characteristic well-supported by extensive clinical studies [ 8 , 9 , 14 , 15 , [145] , [146] , [147] ].…”

Corneal Perforation Self-Healing with an Iris Plug in the Cornea

“…The iris plug is a mechanical closure for corneal ulcer and secures the anterior globe structure. Kobayashi et al [6] presented a 2-week follow-up of iris incarceration as an additional procedure to surgical management of corneal ulcers. After manipulation the patient showed good visual outcome as a result of minimal residual scaring and related astigmatism.…”

Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer

“…A key in the surgical management is to patch the perforated hole first. The autologous iris,16 conjunctival flap,17 sclera,18 and reversed autologous corneal flap19 can be used to seal small perforated holes, but these materials may induce iris anterior synechiae, leakage at the graft–host interface for lack of endothelial cells, or poor looks. For the large perforation, they seem to be ineffective.…”

Adhesive bioactive materials in ocular applications: Toward smart, regenerative, and minimally invasive therapies

“…CTAs are primarily composed of alkyl cyanoacrylate monomers, which are esters of α-cyanoacrylic acid synthesized through the condensation of cyanoacetic acid esters and formaldehyde [ 12 ]. In ophthalmic surgery, CTAs serve as alternatives to sutures and are applied in various contexts, such as cataract incision repair [ 141 ], retinal detachment management [ 142 ], scleral reinforcement [ 143 ], extraocular muscle attachment [ 144 ], and corneal perforation closure [ 145 ]. Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation.…”

“…Notably, despite being an off-label use, CTA remains one of the principal therapeutic options for corneal perforation. As a synthetic bioactive adhesive material for ocular applications, CTA exhibits one of the highest mechanical strengths among its class [ 77 ], a characteristic well-supported by extensive clinical studies [ 8 , 9 , 14 , 15 , [145] , [146] , [147] ].…”