Corneal Gluing Rasik B Vajpayee, Vishal Jhanji, Jacqueline Beltz
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1Step by Step® Corneal Gluing
2Step by Step® Corneal Gluing
Jacqueline Beltz MBBS, FRANZCO Cornea Services Royal Victorian Eye and Ear Hospital Melbourne, Australia Vishal Jhanji MD Cornea Services Royal Victorian Eye and Ear Hospital Melbourne, Australia Rasik B Vajpayee MS, FRCS (Edin), FRANZCO Prof of Ophthalmology Head Corneal and Cataract Surgery Cornea Services Royal Victorian Eye and Ear Hospital Centre for Eye Research University of Melbourne, Australia Foreword by Hugh R Taylor MD, AC
3Published by
Jitendar P Vij
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Step by Step Corneal Gluing
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2009
9788184486858
Typeset at JPBMP typesetting unit
Printed at
4Foreword
I will never forget the first time I heard about the use of corneal glue to seal a corneal perforation in the mid- 1970s. Cries of delight emanated from an examination room in the basement at the Wilmer as this new technique quickly and efficiently resolved one of the most dangerous situations in ophthalmology—a perforated eye. Before the advent of the cyanoacrylate glues, there were no simple methods to treat corneal perforations. Emergency corneal grafting in ‘hot eyes’ with untreated microbial keratitis was rarely successful and ultimate loss of the eye not uncommon.
Beltz, Jhanji and Vajpayee have produced a brilliant distillation of years of experience in this easy-to-read and well-illustrated book. They provide an excellent review of the history of the use of glue for corneal perforations and the indications for when and how it should be applied. More importantly, they give a clear and specific, step-by-step description of how to apply glue and include two alternative methods for different situations. Although glue can be applied at slit lamp, and this is one of its great advantages, I have always found it easier to apply with the help of gravity by having the patient lying flat under the operating microscope.5
The useful section on technique is followed by some very good advice and guidelines on postoperative management and also the surgical alternatives if the corneal gluing does not work.
This is a masterly little book full of useful practical advice. It will be an invaluable source of instruction for trainee ophthalmologists and a useful tool to have close at hand for general ophthalmologists who might only see the occasional perforated corneal ulcer.
Although the use of corneal glue has revolutionised our ability to manage corneal perforations and to save many eyes, it can be a tricky procedure if performed incorrectly. The authors have built on their experience of hundreds of cases seen at the Royal Victorian Eye and Ear Hospital in Melbourne and in the RP Centre in New Delhi. This most useful book will enable all to understand the intricacies of this procedure and the authors have done us all a great service.
Professor Hugh R Taylor md, ac
6Preface
Corneal perforation, or impending corneal perforation, is an ophthalmic emergency that requires immediate diagnosis and intervention. Timing is important, as an open globe is at risk of serious complication such as endophthalmitis, as well as complications associated with hypotony, such as choroidal effusion.
Treatment of corneal perforation should be targeted towards the underlying aetiology, and definitive treatment may require the input of a corneal specialist. Corneal gluing, however, is a safe and simple initial measure that does not require specialised equipment and may be performed safely and effectively by the general ophthalmologist in the clinic.
As these situations may not be encountered frequently, confidence in the technique is often lacking. It is for this reason that we decided to provide a simple module to provide some advice on how best to treat this problem, and how to practically perform a corneal gluing.
Jacqueline Beltz
Vishal Jhanji
Rasik B Vajpayee
7Acknowledgements
With thanks to the medical photography department at Royal Victorian Eye and Ear Hospital, Melbourne, Australia.