Comparative effectiveness of penetrating keratoplasty and conservative cyanoacrylate tissue adhesive application for corneal perforation and thinning.

PURPOSE: To compare outcomes between eyes that underwent penetrating keratoplasty (PKP) following cyanoacrylate tissue adhesive (CTA) application for corneal perforation or thinning and those managed with conservative treatment alone.

METHODS

We conducted a single-centre, comparative cohort study of 189 eyes with corneal perforation or thinning treated with CTA at a tertiary care centre. Eyes were categorised into two groups: those managed with CTA alone and those requiring subsequent PKP. The primary outcome was best-corrected visual acuity (BCVA) at final follow-up. Characteristics and outcomes were compared using Fisher's exact and Mann-Whitney U tests.

RESULTS

Of 189 eyes, 125 (66%) were managed conservatively with CTA alone and 64 (34%) required PKP. In the CTA group, the most common underlying aetiologies were microbial (31%, n = 37), neurotrophic (28%, n = 33), and trauma-related (22%, n = 26). Among eyes requiring subsequent PKP, microbial (46%, n = 25) aetiologies predominated, with viral keratitis more frequently observed (17%; P = 0.018) and trauma less frequently observed (6%; P = 0.008) compared to eyes managed conservatively. Final BCVA was comparable between groups (median logMAR 2.0 [CTA group] and 1.7 [PKP group]; P = 0.382), as was the median change in BCVA from presentation to final follow-up (P = 0.441). Subgroup analyses of corneal thinning and perforation showed consistent findings.

CONCLUSIONS

Visual outcomes were comparable between eyes managed conservatively with CTA and those that underwent PKP, despite more severe baseline disease in the PKP group. These findings underscore the importance of individualised patient selection and may help avoid unnecessary surgical intervention when clinical stability can be achieved conservatively.