Description

With this issue of the CME Journal in Ophthalmology we introduce a new series on How to do it. Simple, and perhaps even complex, surgical and Laser procedures will be presented in a stepwise format. It is hoped that this practical approach, with useful tips and tricks, will enable the novice to perform the procedure and the initiated to polish their technique. The logic and rationale behind some of the steps and techniques will be mentioned to aid understanding of the procedures and allow the surgeon to modify and adapt the described technique to best suit his or her needs. Like with all such presentations, the method, technique or procedure described will represent the current and reasonable standard of clinical practice and not pretend to be the only or the best way in which it should be done.

We begin with one of the simplest of all procedures, corneal gluing (Choong, Daya and Dua) which, despite its simplicity, is often not satisfactorily performed with consequent poor results. It is surprising, and at times amusing, to learn of some of the ideas and concepts of trainee doctors, on this subject. For example, to drop a tiny droplet of glue, through a tuberculin syringe, directly on to the perforation is not a good suggestion.

A question often asked but not dealt with in the article, relates to how often and how long can one vial of glue be used, once opened. It is (in my opinion)
reasonable to seal the tip of the vial, store at 4oC and re-use several times over several months. This was the practice in at least one other leading centre in the West. However, the strict discipline inculcated into theatre sisters and nurses here, may prevent one from adopting this approach. If that be the case,
consider re-sealing the tip and shipping the vial to colleagues in less previliged countries where availibility of glue is inversely proportional to the incidence of perforation!! Some of the commercially available glues used in these countries contain formaldehyde products and may not be ideally suitable for use on the cornea.