The principles of wound closure are as follows:
• If the wound is corneoscleral, the limbus is closed first6, followed by closure of the cornea, and finally the sclera (see Chap. 2.2 and Fig. 2.3.1).
• If the wound is limited to the easily accessible anterior sclera, the "50%" rule applies.
5 Rupture or laceration
6 It is here where the apposing tissue edges can most accurately be paired up with each other.
border of conjunctival takedown limbus border of conjunctival takedown limbus
Fig. 2.3.1 Closure strategy for corneoscleral wounds with a short scleral extension. The numbers represent the order of suture placement (as shown in Fig. 2.2.5b). The limbal and the corneal portions of the wound must be closed first. On the scleral side, the surgeon can start at the limbus and continue suture placement away from the limbus. Alternatively, the "50% rule" can be applied: once the distal end of the wound is visualized and the wound is exposed in its entirety, the initial suture is placed at the half point (50%), the next at 25%, then at 75%, etc
• If the wound is partially underneath an extraocular muscle, the easily accessible part is closed first, followed by the difficult-to-access portion (see below).
• If the wound is posterior, the "close-as-you-go" technique is recommended (see below).
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