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

Eye (2026)Cite this article

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Abstract

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.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Ryan S. Huang

  2. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    Manokamna Agarwal & Clara C. Chan

  3. Department of Ophthalmology, Rambam Health Care Campus affiliated with the Technion – Israel Institute of Technology, Haifa, Israel

    Michael Mimouni

Authors
  1. Ryan S. Huang
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  2. Manokamna Agarwal
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  3. Michael Mimouni
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  4. Clara C. Chan
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Contributions

Ryan S. Huang: Conceptualisation, Methodology, Data curation, Formal analysis, Investigation, Visualisation, Writing – Original draft preparation, Writing – Reviewing and Editing. Manokamna Agarwal: Conceptualisation, Methodology, Investigation, Data curation, Writing – Reviewing and Editing. Michael Mimouni: Conceptualisation, Methodology, Validation, Investigation, Writing – Original draft preparation, Writing – Reviewing and Editing. Clara C. Chan: Conceptualisation, Methodology, Supervision, Project administration, Validation, Resources, Writing – Reviewing and Editing. All authors have equally fulfilled the authorship criteria and contributions outlined by the International Committee of Medical Journal Editors (ICMJE) and approved the current version of the manuscript.

Corresponding author

Correspondence to Clara C. Chan.

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Competing interests

Clara C. Chan: Consultant – Aequus, Abbvie, Admare Bioinnovations, Allergan Inc., Aurion, Bausch & Lomb, Johnson & Johnson Vision, Kala Ophthalmics, Labtician Ophthalmics Inc., Novartis, Santen Inc., Sun Ophthalmics, Thea, Valeo Pharma. Financial support (to institution) – Aurion, Corneat, Claris Bio. Lecture fees – Abbvie, Allergan Inc., Johnson & Johnson Vision, Labtician Ophthalmics Inc., Thea. Michael Mimouni: Consultant – Lapidot Medical, Lumenis, EyeYon Medical, Orasis Pharmaceuticals, Precise Bio, Amntiotek, Labtician. Ryan S. Huang and Manokamna Agarwal have no conflicts of interest.

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Huang, R.S., Agarwal, M., Mimouni, M. et al. Comparative effectiveness of penetrating keratoplasty and conservative cyanoacrylate tissue adhesive application for corneal perforation and thinning. Eye (2026). https://doi.org/10.1038/s41433-025-04201-6

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