Corneal Sealants in Clinical Use: A Systematic Review

ABSTRACT

Aim

To review the use of clinical corneal sealants for the closure of full thickness corneal wounds.

Methods

A systematic review was conducted across CENTRAL, Medline, PubMed, Embase, Scopus, mRCT and ICTRP for the keywords of ‘cornea’, ‘full-thickness wound’, ‘sealant’ and their synonyms. Only evidence level 2 of higher as graded by Oxford Centre of Evidence-based Medicine were included for this review.

Results

Seven studies were included; three randomized controlled trials investigated ReSure® sealant, 2 OcuSeal®, 1 human fibrin glue vs cyanoacrylate and 1 human fibrin glue as an adjunct to sutures vs sutures alone in penetrating keratoplasty. ReSure® was superior to suture for sealing leaking corneal incisions after cataract surgery despite provocation. ReSure® sealant has not been tested on complex full thickness corneal wounds, perforated ulcers or penetrating keratoplasty. OcuSeal® was also able to seal full thickness cornea wound post-cataract surgery to prevent ingress of Trypan blue dye. Human fibrin glue and cyanoacrylate were similarly effective in treating corneal perforations <3 mm of mixed etiologies.

Conclusion

There are limited high-level evidence for corneal sealants. The currently available sealants with human data are ReSure®, OcuSeal®, human fibrin glue and cyanoacrylates. While ReSure® and OcuSeal® are effective post-cataract surgery, there are no data for perforations from other etiologies. Post-approval data from ReSure® registry report good tolerability and no apparent safety concerns.

KEYWORDS:

• Corneal laceration
• sealant
• glue
• adhesive

Acknowledgments

Professors Foster and Watson gratefully acknowledge support from the Australian National Health and Medical Research Council (NHMRC project grant APP1067749). Professor Watson is a Sydney Medical School Foundation Fellow.

Declaration of interest

The authors declare no conflict of interest in the preparation of this manuscript.

Additional information

Funding

This project is funded by the National Health and Medical Research Council (NHMRC) project grant [APP1067749 to Foster and Watson]. Professor Stephanie Watson is a Sydney Medical School Foundation Fellow.