tissue adhesive + bcl in childrenwith microbial keratitis

Tissue Adhesive + BCL in children

with Microbial Keratitis

Tanuj R. Sharma

Mayur R. Moreker

Ashwin B. Bafna

Dhyanesh K. Desai

Rashmikant C. Patel

Taparia Institute of Ophthalmology

Bombay Hospital Institute of Medical Sciences

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

Cyanoacrylate glue

•Early application of cyanoacrylate glue with bandage

contact lens is known to aid management of small corneal

perforations, corneal melts and wound leaks.

•It may also avoid the need for tectonic penetrating

keratoplasty

Vote BJ, Elder MJ. Cyanoacrylate glue for corneal perforations: a description of a

surgical technique and a review of the literature

Clin Experiment Ophthalmol. 2000 Dec;28(6):437-42.

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

•Cyanoacrylate glue prevents collagenase production thus

preventing stromal melting.

•Cyanoacrylate also have significant bacteriostatic activity

against gram-positive organisms.

Cyanoacrylate glue

Vote BJ, Elder MJ. Cyanoacrylate glue for corneal perforations: a description of a

surgical technique and a review of the literature

Clin Experiment Ophthalmol. 2000 Dec;28(6):437-42.

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

Objective

To report use of Cyanoacrylate Tissue Adhesive and Bandage Contact Lens (TA + BCL) for urgent tectonic support to avert therapeutic keratoplasty in children with microbial keratitis and imminent / apparent perforation

Methods•Patient 1 (7 years) - Large perforated paracentral corneal infiltrate with endoexudates.•Patient 2 (10 years) - Paracentral corneal infiltrate with central descemetocoele, impending perforation. •Both underwent TA + BCL (AC Reformation in Patient 1) which averted therapeutic keratoplasty

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

Corneal Perforation

Endoexudates

Infiltrates

Patient 1 - Presentation

Culture: Fungus (Zygomycosis spp.)

Steps of Tissue Adhesive + Bandage Contact Lens ProcedurePRE - PROCEDURE DRYING THE FIELD WITH SPONGE

POST - PROCEDURE APPLICATION OF GLUE

Tissue Adhesive

Bandage CL

Day 1 post TA + BCL

Vascularized scar

Visual axis

3 months post TA + BCL

BCVA: 20/30

Impending Perforation

Infiltrate

Patient 2 - Presentation

Smear: Gram Negative Bacilli

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

Tissue Adhesive

Bandage CL

Immediate Post TA + BCL

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

Vascularized scar

Visual axis

2 months post TA + BCL

BCVA: 20/60

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.

• Cyanoacrylate glue + Bandage Contact Lens offers urgent

tectonic support and helps avert urgent therapeutic

keratoplasty achieving excellent visual outcome in children

with paracentral corneal infiltrates

Conclusion

Thank you

Dr. Tanuj R. SharmaTaparia Institute of OphthalmologyBombay Hospital Institute of Medical Sciences , Mumbai.