L A

Fig. 2.2.11 Closure of a small corneal wound. Closure is correct here in terms of suture length (longer in the periphery and shorter in the center); however, the knots still need to be buried, and leaving the tags too long makes this difficult. The tags may also cause additional problems once turned into the AC

Fig. 2.2.12 Closure of a long corneal wound. A properly closed wound., note that the sutures are longer in the periphery and that scar formation is minimal (Courtesy of B. Hamill)

Fig. 2.2.13 Closure of a long corneal wound. A similarly long wound as in Fig. 2.2.11; however, the suture bites are arbitrary in terms of length, and introduction sequence is also presumed to have been haphazard. Suture placement was obviously not based on a carefully designed plan. Furthermore, the sutures are too tight, making the surface uneven (bulging wound edges). It will take a long time for this cornea to clear, and permanent visual impairment is inevitable

Fig. 2.2.13 Closure of a long corneal wound. A similarly long wound as in Fig. 2.2.11; however, the suture bites are arbitrary in terms of length, and introduction sequence is also presumed to have been haphazard. Suture placement was obviously not based on a carefully designed plan. Furthermore, the sutures are too tight, making the surface uneven (bulging wound edges). It will take a long time for this cornea to clear, and permanent visual impairment is inevitable

Fig. 2.2.14 Corneal blood staining. This wound was closed with evenly spaced sutures, which appears esthetical but causes flattening. Nonetheless, closure technique in this case has relatively little significance. The cornea has become nontransparent due to blood staining; posterior segment surgery is impossible without using the TKP (see Chap. 2.15), making PK unavoidable1

Fig. 2.2.14 Corneal blood staining. This wound was closed with evenly spaced sutures, which appears esthetical but causes flattening. Nonetheless, closure technique in this case has relatively little significance. The cornea has become nontransparent due to blood staining; posterior segment surgery is impossible without using the TKP (see Chap. 2.15), making PK unavoidable1

1 Endoscopy is also an option (see Chap. 2.20), but it is doubtful that this cornea will escape the need for a PK.

Fig. 2.2.15 Scar formation following closure of a corneal wound. Although scarring cannot be avoided once the wound is deeper than the epithelium, it can be minimized by proper suturing techniques and the judicious use of corticosteroids postoperatively

Was this article helpful?

0 0

Post a comment