Clinical Outcomes and Predictive Factors for Penetrating Keratoplasty Following Glue Application for Corneal Perforation and Thinning.

Abstract

To describe the clinical outcomes and identify predictive factors associated with the need for penetrating keratoplasty (PKP) following cyanoacrylate tissue adhesive (CTA) application for corneal perforation or thinning. Retrospective clinical cohort study. We conducted a single-center, retrospective cohort study of 189 eyes treated with CTA for corneal thinning or perforation between January 2006 and August 2024 at a tertiary care center. The primary outcome was the best-corrected visual acuity (BCVA) at final follow-up. Univariable and multivariable logistic regression models were used to identify associations between baseline and clinical characteristics with progression to PKP following CTA management. Of 189 eyes treated with CTA, 64 (34%) underwent subsequent PKP after CTA application. Multivariable regression identified several independent predictors of needing PKP, including central or paracentral defect location (vs peripheral, OR = 2.98, 95% CI = 1.27-6.91, P = .012), multiple CTA applications (vs single, OR = 2.70, 95% CI = 1.42-5.15, P = .003), worse baseline BCVA (logMAR >2 vs logMAR <1; OR = 3.10, 95% CI = 1.35-6.58, P = .005), and viral keratitis (OR = 3.55, 95% CI = 1.21-9.58, P = .020). Trauma was associated with lower odds of PKP (OR = 0.26, 95% CI = 0.08-0.80, P = .014). Median final BCVA following PKP was 2.0 logMAR (IQR: 1.5-2.3), with no significant difference from baseline (P = .585). PKP remains an important intervention for eyes refractory to CTA; however, final visual outcomes are limited. Early identification of high-risk clinical features may help guide timely decision-making and set realistic expectations regarding prognosis.