Anterior lens capsule: Biological drape

Small perforations are often managed with cyanoacrylate glue - bandage contact lens (BCL). An additional layer with substances like sterile drape often enhances the strength of the glue. Herein, we describe a novel method of using anterior lens capsule as biological drape to secure perforation. The anterior capsule was secured from femtosecond laser–assisted cataract surgery (FLACS) and placed over the perforation after folding it twice. The area was dried and a small aliquot of cyanoacrylate glue was applied over it. The BCL was applied over it after the glue was dry. In our series of five patients, none of them needed repeat surgery and all cases healed by three months without vascularization. It is a unique technique to secure small corneal perforations.

Management of descemetocele: Our experience and a simplified treatment algorithm

Purpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye?care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow?up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non?perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non?functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

The Impact of Double Fixation with Titanium Tack and N-Butyl Cyanoacrylate Glue (NBCG) Mesh Fixation versus NBCG Fixation Only in Totally Extra-Peritoneal Hernioplasty with 3-Dimensional Configured Polyester Mesh: A Comparative Study

PURPOSE: Our aim is to compare 3-dimensional mesh fixation using titanium tacks combine with n-butyl cyanoacrylate glue (NBCG) (COMBINE group) versus NBCG only (NBCG group) in totally extraperitoneal inguinal hernioplasty (TEP). METHODS: This is a retrospectively study of patients diagnosed with unilateral inguinal hernia and underwent TEP with 3-dimensional configured polyester mesh fixation using titanium tacks combine NBCG or NBCG only at the University of Hong Kong-Shenzhen Hospital with data prospectively collected. Operative details and outcomes were compared including: operating time, size of defect, total hospital cost, post-operative pain scores and recurrence. RESULTS: From 08.2013 to 03.2016 a total of 219 patients were included. There was no significant difference between COMBINE group and NBCG group in mean age (52.5 years versus 48.2 years), mean size of defects (2.4 cm versus 2.6 cm), and operating time (121 mins versus 111 mins). There were significant differences between COMBINE group and NBCG group in total hospital cost (3035 USD versus 2022 USD), post-operative pain score on day 2 to day 4 (VAS: 1.4 versus 1.0, 1.0 versus 0.4, 0.5 versus 0.2). There was one recurrence in COMBINE group (p=0.276) with overall recurrence of 0.46%. CONCLUSION: Patients with inguinal hernia underwent TEP with 3-dimensional configured polyester mesh with NBCG fixation only having comparative surgical outcome to COMBINE group. A recurrence of 0.46% can be achieved with this combination. Tacks fixation may cause more post-operative pain and increase hospital cost. Use of N-butyl cyanoacrylate glue in TEP is safe and effective in our clinical series.

A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices.

Background : There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices. Aim: Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices. Methods: One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group l: 75 patients) or cyanoacrylate injection (group ll: 75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients. Results: Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p =0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group l. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I. Conclusion: EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.

Bronchoscopic management of bronchopleural fistula.

In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.

Fibrin glue in ophthalmology.

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.

Manufacture and Theory of a New Kind of Intravascular Soluble Hollow Stent for Vascular Anastomosis with Adhesive, Cyanoacrylate Glue / 医疗卫生装备

Objective To research and make one kind of intravascular soluble hollow stent for vascular anastomosis. Methods According to the chemical industry, CaCl2, polyethylene glycol (PEG)and gelatin were used to make one kind of intravascular soluble hollow stent for vascular anastomosis, whose surface was covered with CaCl2 membrane(CaCl2 hollow stent). After putting the stent into the two cut sides of vascular, the author put the two sides together, and dropped alginic acid sodium solution, CaCl2 solution, and glue respectively. As soon as the glue solidified, the anastomosis was finished. Results The CaCl2 hollow stent could not only support the cannel of vascular, but also generate two membrane in the two side of anastomosis site. Thus the thickness of sealant was increased. It was effective to prevent leaking of cyanoacrylate glue and its toxicity. Conclusion The CaCl2 hollow stent can generate two membrane in the two side of anastomosis site, and could increase seal effectively. Using this stent could improve the anastomosis patency by increasing the sealant thickness, and preventing leakage of cyanoacrylate glue and its toxicity.

Study of Sealant Gels for Vascular Anastomosis with Adhesive, Cyanoacrylate Glue and Intravascular Soluble Hollow Stents / 医疗卫生装备

Objective To research and make one kind of sealant gel to prevent glue from leaking effectively,and protect vascular anastomosis site,raise the vascular anastomosis patency.Methods The experiment was carried out based on theory and methods in chemistry;According to the membrane performance,the membrane water solubility,and other characters,the author took experiment on the alginic acid sodium,chitsan,the gelatin and other biological materials.Results Through the experiment by membrane performance,the alginic acid sodium met the requirement,which became the membrane with the CaCl2 reaction at once.Its membrane was not dissolved in the water.And the characters of its 1%-3% solution were good on fluidity and surface contact angle determines.The biological compatibility of the compound of it with 20% CaCl2 solution was good.Conclusion The characters of the composition,which is double component sealant made from 1-3% alginic acid sodium and 20%CaCl2 solution,is best in the biological experiment.Before new medical glue appeared in clinical,this gel is hopeful to be applied in clinic and provide theory basis for clinical anastomosis.

The Results of Cyanoacrylate Glue Application for Corneal Perforation and Impending Perforation

PURPOSE: To investigate the effectiveness of cyanoacrylate glue application in cases of corneal perforation or impending perforation due to refractory keratitis. METHODS: Cyanoacrylate glue was applied on 6 cases of fungal keratitis, 3 cases of herpetic keratitis, and 3 cases of bacterial keratitis from July 1998 to June 2002. 2 cases were corneal perforations and 10 were impending perforations. Cyanoacrylate glue was applied on stromal melting area including normal epithelium. When fibrovascular tissue grew beneath the glue sufficiently, glue was removed. When glue was sloughed off spontaneously or fibrovascular tissue was found to be insufficient, glue was reapplied. RESULTS: After average follow up of 25 weeks, the corneal surface was stabilized in 11 eyes except 1 case of fungal keratitis that had broad area of stromal melting(5.4mm). After use of glue, process of stromal melting was found to be discontinued. As fibrovascular tissue grew up beneath the glue, corneal surface became stable. Average diameter of stromal melting area and of glue application area was 4.0mm and 4.4mm respectively. Average duration of glue application was 17 weeks. CONCLUSIONS: Cyanoacrylate glue application appears to be an effective and convenient method in cases of corneal perforations and impending perforations associated with advanced and extensive fungal, bacterial, and herpetic keratitis with active keratolysis.

The Effect of Cyanoacrylate Glue on Wound Healing of The Cornea Following Rabbit Radial Keratotomy

The authors performed conventional radial keratotomy(RK) in one eye(Keratotomy group) and RK with cyanoacrylate glue in the other eye(Glue group) for 5 rabbits and compared the diopteric changes between before and four weeks after operation. The refractory power(mean+/-SD) of the cornea meassured with keratometer before the RK was 51.53 +/- 0.77 diopter(D) in Keratotomy group and 51.98 +/- 0.84D in Glue group. It was reduced four week after RK by 4.73 +/- 1.94D and 7.15 +/- 1.46D. respectively. The change of refractive power between two groups showed a statistically significant difference(p0.05). Histologic examination was performed with 4 eyes of 2 rabbits 4 week after RK. It was found in both groups that same pattern of epithelial plug and irregulaly oriented collagen fibers in stroma. However, the epithelial plug was more prominent in RK group than in Glue group. In conclusion, it was found that that RK with cyanoacrylate glue was more effective in reduction of keratometic diopter than keratotomy alone and the reason seemed to be a decreased epithelial plug in a keratotomy wound.