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. 2026 Jun 23;12(4):e71046. doi: 10.1002/vms3.71046

Hyaluronic Acid‐Based Photocurable Glue Application as an Alternative Surgical Approach for Corneal Injuries in Canine Patients: A Case Series

Myeongjee Kwon 1, Hyeseon Lee 2, Jungyeon Yong 1, Haerin Yoon 1, Jiyi Hwang 1, Ji Seung Jung 1, Donghee Kim 1, Sungin Lee 1, Seung Yun Yang 2,3, Kyung‐Mee Park 1,✉
PMCID: PMC13288253  PMID: 42334009

ABSTRACT

Effective non‐surgical alternatives are required for managing severe corneal injuries in dogs when surgical intervention is not feasible. This case series evaluated the therapeutic potential of hyaluronic acid (HA)‐based photocurable glue (HA photoglue, Teratouch‐ETM, SNVIA) in three dogs with deep corneal injuries. Case 1 was a 16‐year‐old Pekingese with systemic disease presenting with a descemetocele. Case 2 was a 14‐year‐old Maltese with diabetes mellitus and a corneal perforation. Case 3 was a 10‐year‐old mixed‐breed dog with a corneal laceration involving 50 % stromal depth. All cases underwent topical anaesthesia and light sedation. A 20 µL drop of HA photoglue was applied to the lesion and photocrosslinked with short visible light (405 nm, 4.3 s). Applications were repeated during follow‐up depending on lesion size and adhesive stability. In Case 1, 16 applications over 9 months maintained corneal integrity and transparency without perforation or inflammation. In Case 2, five sequential applications over 3 months achieved complete re‐epithelialisation and stromal remodelling. In Case 3, a single treatment resulted in full epithelial closure by two weeks, and corneal clarity and visual function were fully restored by eight weeks. This case series suggests that HA photoglue may serve as a safe and minimally invasive therapeutic approach for canine corneal injuries, providing mechanical stabilisation and demonstrating clinical potential when conventional surgery is not feasible.

Keywords: corneal perforation, deep corneal ulcer, descemetocele, hyaluronic acid, light‐responsive glue, tissue adhesive

• Hyaluronic acid (HA)–based photocurable glue was applied to deep corneal injuries in dogs as a minimally invasive alternative when surgery was not feasible.

• The adhesive was delivered to the lesion and rapidly photocrosslinked using 405 nm visible light, creating a stable protective barrier.

• HA photoglue provided structural support and helped maintain corneal integrity in the three cases, suggesting potential usefulness as an alternative option for severe corneal defects.

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1. Introduction

Corneal injuries, including descemetoceles, lacerations, perforations, and deep ulcers, are critical ophthalmic conditions that necessitate prompt medical or surgical management to prevent vision loss and preserve ocular integrity (Jhanji et al. 2011). These conditions often arise suddenly and necessitate prompt and effective treatment. However, in veterinary practice, surgical intervention is not always feasible due to the patient's systemic health issues or the financial constraints of owners. This underscores the urgent need for effective, non‐surgical alternatives to stabilise such conditions and prevent further deterioration.

Ocular tissue adhesives have emerged as invaluable tools for managing severe corneal injuries, particularly when surgical intervention is not an option (Ollivier et al. 2001; Panda et al. 2009). These adhesives provide structural support, stabilise the corneal surface, and halt disease progression (Guhan et al. 2018; Park et al. 2011). In recent years, several veterinary ophthalmic studies have further emphasised their potential as minimally invasive alternatives for corneal repair, including the use of cyanoacrylate, platelet‐rich fibrin membranes, and crosslinked hyaluronic acid formulations (Arad et al. 2026, Demir et al. 2022, Rodriguez et al. 2021;).

Commonly used adhesives in ophthalmology include cyanoacrylate‐based adhesives and fibrin glue (Joksimovic et al. 2023; Wang et al. 2024; Sharma et al. 2003). Cyanoacrylate adhesives can be used for corneal perforations due to their rapid curing properties and ability to provide temporary sealing prior to definitive treatments, such as corneal transplants (Yin et al. 2019). In clinical practice, they are readily available and inexpensive, making them practical temporising agents for small perforations. However, these adhesives, based on reactive chemistry, are brittle, can induce inflammation after application, and have limited transparency, which hinders real‐time monitoring of the healing process (Ferry and Barnert 1971; Carlson and Wilhelmus 1987). In contrast, fibrin glue, which mimics the blood clotting mechanism, offers excellent biocompatibility and minimal inflammatory responses while naturally degrading over time (Dhillon 2011). Despite these advantages, its high cost and potential for allergic reactions restrict its use in certain cases (Everts et al. 2006; Alston et al. 2008).

Given these limitations, the development and clinical evaluation of new alternative adhesives are of great importance. Hyaluronic acid (HA)‐based glues activated by light exposure have emerged as a promising solution that addresses many of the shortcomings of conventional adhesives (Lee et al. 2022). The HA‐based photocurable glue (HA photoglue) offers favourable biocompatibility and transparency, forms a smooth and flexible surface, minimising irritation on the corneal surface. Additionally, HA photoglue rapidly seals wounds upon exposure to non‐toxic, low‐energy light, providing stable adhesion even on wet ocular surfaces (Lee et al. 2022).

This case series describes three canine cases with various corneal conditions, including descemetoceles, perforations, and stromal lacerations, in which HA photoglue was applied, and aims to discuss its potential as a non‐surgical alternative treatment option.

2. Case

This case series involved privately owned dogs, and all procedures were performed with informed client consent. Three canine patients were referred to the Veterinary Medical Teaching Hospital of Chungbuk National University, Cheongju, Republic of Korea for ophthalmic disease treatment. The patients underwent routine ophthalmic examinations, including Schirmer tear test (STT), rebound tonometry (Tonovet plus, I‐care, Vantaa, Finland), and slit‐lamp biomicroscopy (MW 50D, Shigiya, Tokyo, Japan). Visual status was assessed using the menace response, while the dazzle response and pupillary light response (PLR) were used as indicators of retinal and neurologic function. Anterior segment optical coherence tomography (OCT; RTVue, Optovue Inc., Fremont, CA) was additionally performed in selected cases to obtain corneal structural information.

2.1. HA Photoglue Application Procedure

The same protocol was applied in all three cases. To achieve conformal adhesion and stable hydrogel formation, a photocurable hyaluronic acid‐based glue (Teratouch‐E, SNVIA, Ltd., Busan, Korea) was used following previously described methods with minor modifications (Lee et al. 2022; Lee et al. 2024). The affected eye was anaesthetised with topical 0.5% proparacaine, followed by thorough irrigation with sterile normal saline and 0.5% povidone–iodine solution; however, in cases with corneal perforation, only sterile saline was used. The ulcerated surface was gently debrided using a sterile cotton‐tipped applicator to remove any loose epithelium and necrotic tissue, thereby improving adhesive contact. Light sedation was then induced with butorphanol (0.1 mg/kg, IV), and the patient was positioned in a seated posture with the head gently immobilised. The corneal surface and adjacent epithelium were carefully dried using polyvinyl alcohol spears, and 20 µL of HA photoglue (Teratouch‐E, SNVIA Co., Ltd., Busan, Korea) was applied to the lesion using a pipette. (Figure 1A) The adhesive was then irradiated with a light‐curing device (405 nm, CNS2‐0405, SNVIA Co., Ltd., Busan, Korea) for 4.3 s to form a hydrogel barrier layer. (Figure 1B) Depending on the size and condition of the lesion, the same volume and photocuring step were repeated once or twice to ensure firm adhesion. (Figure 1C) Manual assistance was provided when necessary to prevent accidental contact between the glue and the eyelids.

FIGURE 1.

FIGURE 1

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Application procedure of hyaluronic acid‐based photocurable glue (HA photoglue). (A) Using a pipette, 20 µL of HA photoglue was evenly applied to the ulcerated area. (B) The applied adhesive was exposed to visible light (405 nm) for 4.3 s (0.98 J/cm2) to form a hydrogel barrier layer through photocrosslinking. (C) Post‐application slit‐lamp examination image showing a smooth and transparent surface (indicated by white arrows).

2.2. Case 1

A 16‐year‐old neutered male Pekingese presented with a corneal descemetocele in the right eye, accompanied by conjunctival hyperaemia and mucopurulent discharge. Given the lesion's location and morphology, as well as the breed characteristics, the shallow orbit with protruding globes and mechanical irritation from nasal fold hairs were considered the most likely contributing factors. In addition, self‐trauma or other minor injuries could not be ruled out, although the exact cause was not identified by the owner. Ophthalmic examination revealed a 2‐mm central descemetocele with marked stromal thinning, neovascularisation, and corneal oedema in the periphery (Figure 2A). Intraocular pressure was 12 mmHg (reference range: 10–25 mmHg), and the STT result was 20 mm/min (reference range: ≥ 15 mm/min), both within normal limits, indicating adequate tear production (Gould and McLellan 2014). Both menace response and dazzle reflex were positive. Anterior segment OCT revealed a central descemetocele bordered by a thin residual stromal layer measuring approximately 125 µm in thickness. Given the patient's stage C chronic mitral valve disease and chronic renal failure, the owner opted against general anaesthesia.

FIGURE 2.

FIGURE 2

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HA photoglue application for descemetocele in Case 1. (A) Descemetocele before adhesive application. (B) Four weeks post‐application of HA photoglue. (C) Nine months post‐application, showing stable maintenance of the cornea. No evidence of inflammation, infection, pain, and perforation was shown.

To reinforce the stromal defect and reduce the risk of perforation, HA photoglue was applied to fill and stabilise the ulcer bed. Because the patient's facial conformation – specifically, the nasal fold hair and tongue – frequently contacted the cornea, the risk of secondary infection was considered high. Therefore, a combination of broad‐spectrum antibiotic eye drops was empirically initiated, consisting of moxifloxacin (Vigamox, Novartis, Basel, Switzerland) and tobramycin (Ocuracin, Samil Pharmaceutical Co., Ansan, Korea). Subsequent bacterial culture identified Staphylococcus schleiferi, which showed sensitivity to these agents, confirming the appropriateness of the initial antibiotic selection. The same regimen was maintained, with dosing frequency gradually tapered from more than six times daily to two to three times daily as the corneal condition stabilised.

One week after HA photoglue application, partial detachment of the adhesive was observed, prompting reapplication. Over the following 9 months, HA photoglue was reapplied at approximately two‐week intervals, totalling 16 applications (Figure 2B). Two months later, peripheral corneal oedema surrounding the descemetocele had improved, and the previously loose and repeatedly sloughing epithelium was completely re‐epithelialised; however, stromal and epithelial regeneration did not occur within the descemetocele area. No adverse effects related to the adhesive were observed, and no conjunctival hyperaemia, stromal oedema, pain response, or anterior chamber inflammation was noted (Figure 2C). During the 9‐month follow‐up period, no complications such as inflammation, ulcer progression, infection, or perforation occurred, and vision remained well preserved throughout.

2.3. Case 2

A 14‐year‐old neutered male Maltese with diabetes mellitus (DM), hyperadrenocorticism (HAC), bilateral keratoconjunctivitis sicca (KCS), and bilateral cataracts had been under treatment at our hospital for a corneal ulcer and uveitis in the left eye. The dog was presented with acute ocular pain. STT was 10 mm/min, and intraocular pressure was 21 mmHg. Menace response, dazzle and PLR reflexes were all negative.

At the emergency visit, a 1‐mm full‐thickness corneal perforation was identified in the central cornea. Although a fibrin plug was partially present over the lesion, aqueous humour leakage resulted in a shallow anterior chamber with close apposition between the cornea and iris (Figure 3A). Fluorescein staining revealed a broad area of uptake, approximately 6 mm in diameter, surrounding the perforation margin, whereas the small perforation site itself was not stained. Corneal swab cytology revealed bacterial cocci and numerous neutrophils, supporting the suspicion of bacterial infection. The owner declined additional diagnostic evaluations, including anterior segment OCT and antimicrobial susceptibility testing, due to financial constraints.

FIGURE 3.

FIGURE 3

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HA photoglue application for corneal perforation in Case 2. (A) Corneal perforation (white arrow) before adhesive application. (B) One week post‐application of HA photoglue. (C) Eight weeks post‐application, corneal perforation was completely healed.

Due to concerns about anaesthesia associated with advanced age and underlying endocrine diseases, as well as financial constraints, the owner declined surgical correction using conjunctival grafting or extracellular matrix transplantation (such as small intestinal submucosa [SIS] or acellular matrix grafts). HA photoglue was applied following the same protocol as described in Case 1 to fill and seal the perforation. Systemic non‐steroidal anti‐inflammatory drugs (NSAIDs, meloxicam, 0.1 mg/kg, orally, once daily for five days, Boehringer Ingelheim, Ingelheim am Rhein, Germany) and antibiotics (Amoxicillin‐Clavulanate, AMC, 12.5 mg/kg, orally, twice daily for five days, Amocla tab, Kuhnil Pharm. Co., Ltd., Seoul, Korea) were administered. Additionally, broad‐spectrum antibiotic eye drops, including ofloxacin (Ocuflox, Samil Pharmaceutical Co.) and tobramycin, together with serum eye drops, were administered intensively (approximately six times daily) during the initial 2 weeks and gradually tapered to twice daily by 3 months after HA photoglue application. One week after HA photoglue application, partial detachment of the adhesive around the perforation was observed, prompting reapplication. Over the following 3 months, HA photoglue was reapplied at 2‐ to 3‐week intervals, totalling five applications. The perforation site was sealed and complete stromal and epithelial regeneration was achieved (Figure 3B, C). However, visual function did not recover.

2.4. Case 3

A 10‐year‐old mixed breed dog presented with corneal opacity and pain response in the right eye after a walk. Ophthalmic examination showed a STT result of 24 mm/min and an intraocular pressure of 20 mmHg. Both menace response and dazzle reflex were normal. Fluorescein staining was positive, indicating a corneal laceration (Figure 4A). Anterior segment OCT revealed a total corneal thickness of 865 µm at the lesion site, with the laceration involving approximately 50% of the corneal depth.

FIGURE 4.

FIGURE 4

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HA photoglue application for corneal laceration in Case 3. (A) Corneal laceration (white arrow) prior to adhesive application. (B) Two weeks post‐application, showing the healing process of the corneal laceration. (C) Eight weeks post‐application, demonstrating a smooth and transparent cornea without corneal opacity.

HA photoglue was applied following the same protocol as described in Case 1 to stabilise the laceration site and relieve discomfort, serving as a therapeutic treatment to promote corneal healing. Systemic NSAIDs (Carprofen 2.2 mg/kg, orally, twice daily for three days, Rimadyl, Zoetis, Parsippany, NJ, USA) were administered. In addition, topical antibiotic eye drops (ofloxacin and tobramycin) and hyaluronic acid eye drops (Lacure, Samil Pharmaceutical Co.) were administered to support ocular healing and prevent infection. Antibiotics were applied intensively in the early phase (approximately six times daily) and gradually tapered to two to three times daily as the corneal condition stabilised.

One week post‐application, the pain had subsided, and most of the photoglue had already sloughed off, while the lesion showed near‐complete epithelialisation on fluorescein staining without signs of fibrosis or neovascularisation. Two weeks post‐application, fluorescein staining was completely negative, confirming epithelial coverage. Eight weeks post‐application, the cornea exhibited a smooth and transparent surface, free from opacity or irregularities, progressively regaining its normal structure and function, and vision was preserved throughout follow‐up (Figure 4B, C).

3. Discussion

In this case series, we evaluated the clinical applicability of hyaluronic acid (HA)‐based photocurable glue as a minimally invasive treatment for canine corneal ulcers, descemetoceles, and perforations in 3 dogs. Clinical assessments demonstrated stable corneal integrity, pain relief, and the absence of major complications throughout the follow‐up period. These results suggest that HA photoglue can serve as a practical and biocompatible alternative for corneal wound management, particularly in patients unsuitable for anaesthesia or surgical repair.

Corneal ulcers, descemetoceles, and perforations in dogs require prompt intervention to preserve vision and prevent pain and globe rupture (Ledbetter and Gilger 2013; Joksimovic et al. 2023). Conventional surgical approaches such as corneal grafts and conjunctival flaps are effective but require general anaesthesia and carry important limitations, including risks of corneal scarring, graft dehiscence, persistent infection, delayed healing, and postoperative vascularisation that may compromise visual outcomes. Cyanoacrylate adhesives have been effectively used as an alternative to surgical intervention for corneal ulcers; however, they may induce adverse effects such as inflammation, brittleness, and opacity (Bhatia 2006; Cavanaugh and Gottsch 1991; Leahey and Gottsch 1993). In addition, their exothermic polymerisation may further damage fragile tissues such as descemetoceles, and if glue inadvertently enters the anterior chamber, it may polymerise on intraocular surfaces, resulting in endothelial toxicity, synechiae or secondary glaucoma (Weiss et al. 1983; Leahey et al. 1993; Markowitz et al. 1995; Deshmukh et al. 2020). Hydrogel‐based alternatives, particularly those derived from HA, offer superior biocompatibility and support tissue regeneration by promoting corneal epithelial cell migration and proliferation (Guter and Breunig 2017; Gomes et al. 2004; Inoue and Katakami 1993). Recently developed HA photoglue addresses many of these shortcomings by adhering strongly to moist ocular surfaces, curing rapidly under safe light exposure, and maintaining transparency for ongoing clinical monitoring. Specifically, the HA photoglue is composed of hyaluronic acid chains functionalised with both short and long methacrylate groups, enabling rapid radical‐mediated photocrosslinking within a few seconds (< 5 s) under low‐energy white‐light exposure (< 1 J/cm2, 320–500 nm). This process forms a multilength interpenetrating hydrogel network with approximately 90% water content and > 95% optical transparency across the visible spectrum, ensuring clear vision after application. The multilength network architecture enhances mechanical stability and burst pressure while maintaining flexibility and lubricity suitable for dynamic ocular environments. Notably, in previous burst‐pressure testing using punctured thin collagen sheets, the HA photoglue demonstrated sufficient burst strength (∼ 120 mmHg) to withstand normal intraocular pressure (∼ 20 mmHg) in the human eye. These features contribute to firm and watertight tissue adhesion under wet and dynamic conditions, resulting in stable sealing and minimal ocular sensation, as demonstrated in a rabbit corneal incision model (Lee et al. 2022). These features make HA photoglue a promising adjunct for corneal wound management, particularly in cases where surgical intervention is not feasible. However, clinical data regarding the intraocular safety of HA photoglue are currently lacking, as its use in this cases was limited to the corneal surface.

The presented cases emphasise several key advantages of HA photoglue. First, HA photoglue could be applied and cured rapidly without general anaesthesia, enabling prompt and minimally invasive use. The formed adhesive layer effectively reinforced and protected the thinned or perforated cornea, maintaining stable adhesion for approximately two weeks with good biocompatibility. Second, the transparency of the adhesive facilitated regular monitoring of the healing process, an essential feature for managing conditions prone to recurrence or complications. Moreover, HA photoglue exhibited minimal inflammatory response, caused no corneal irritation or pain, and demonstrated an effective sealing effect in small corneal perforations. However, a limitation was that the adhesion of HA photoglue to the corneal surface lasted for only about one to two weeks on average, necessitating reapplication approximately every two weeks. In the case of a descemetocele, no evidence of stromal or vascular ingrowth into the HA photoglue was observed, and complete tissue regeneration within the glued area did not occur.

Although not examined in this case series, HA‐based hydrogels have been reported to serve as drug reservoirs capable of controlled local delivery of antibiotics and growth factors (Kapusta et al. 2023; Andrade del Olmo et al. 2022). Building on this property, future applications of HA photoglue could incorporate antibiotics, anti‐inflammatory agents, and growth factors, thereby enhancing infection control and supporting corneal regeneration. The advancement of this technology may accelerate corneal healing and minimise patient discomfort caused by frequent administration of topical medications.

This case series has inherent limitations. The small number (n = 3) of cases restricts generalisability, and objective quantification of healing parameters – such as stromal thickness recovery, pain scores, or serial OCT monitoring – was not performed. Thus, the findings rely mainly on descriptive clinical observations. Another limitation is that adjuvant treatments, including the type and dosage of topical and systemic medications, were not standardised across cases due to individual differences in corneal and systemic conditions. In addition, corneal cytology and/or corneal culture and sensitivity testing were performed in only one case, which limits the ability to fully evaluate the role of infection control in the healing process. However, antibiotics were primarily used for infection control and are unlikely to have directly influenced the adhesive or wound‐healing effects of HA photoglue. The permeability of HA photoglue to concurrently administered topical antibiotics or other medications in clinical settings also remains to be fully elucidated. Furthermore, fluorescein staining was not performed while HA photoglue remained on the corneal surface; therefore, the fluorescein staining pattern under the presence of the adhesive could not be determined.

4. Conclusion

HA photoglue (Teratouch‐ETM) may represent a promising, minimally invasive alternative for managing corneal injuries in dogs. Its biocompatibility, transparency, and superior mechanical support suggest potential utility, particularly in cases where conventional surgery is not feasible. Although challenges remain, such as accessibility, the need for repeated applications, limited long‐term data, and the small sample size of this case series, these preliminary observations indicate that HA photoglue could provide clinical benefits in selected cases. Further research is needed to refine its applications, address existing limitations, and expand the clinical evidence base. These efforts could pave the way for broader adoption of HA photoglue, potentially extending its application to human ophthalmology.

Author Contributions

Myeongjee Kwon: Conceptualisation, investigation, writing – original draft, writing – review & editing. Hyeseon Lee: Resources. Jungyeon Yong: Data curation. Haerin Yoon: Data curation. Jiyi Hwang: Data curation. Ji Seung Jung: Data curation. Donghee Kim: Data curation. Sungin Lee: Supervision. Seung Yun Yang: Supervision, writing – review & editing. Kyung‐Mee Park: Supervision, writing – original draft, writing – review & editing, conceptualisation.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government. (MSIT) (RS‐2024‐00344226 and RS‐2024‐1289001). This study was also funded by the Ministry of Science and ICT and the Korean Fund for Regenerative Medicine (KFRM) grant (the Ministry of Science and ICT, the Ministry of Health & Welfare) No. 22A0101L1‐11.

Ethics Statement

The authors confirm that the ethical policies of the journal, as noted on the journal's author guidelines page, have been adhered to. No ethical approval was required as this is a case report.

Patient Consent Statement

Written informed consent for publication of the clinical details was obtained from the dog's owner.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authors have nothing to report.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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