Suture Removal

If full-thickness sutures have been used (Fig. 2.2.6b), certain precautions must be taken to prevent endophthalmitis development following suture removal.

O Cave

Removal of a full-thickness corneal suture should be regarded as if an intravitreal injection were given; proper disinfection of the lids and conjunctiva with betadine (10 and 5%, respectively) and the use of a lid speculum is recommended.

• master the techniques of examining the cornea at the slit lamp

• have increased concern for injuries with little or no pain

• be careful not to push a deep corneal FB into the AC by inappropriate removal techniques

• plan all aspects of wound closure before introducing any suture into the cornea

• make use of the benefits of full-thickness sutures

• hesitate to start a new therapy if on current management the corneal erosion keeps recurring

• neglect to consider all posttreatment eventualities (such as rubbing of the eye) when deciding whether to suture an apparently self-sealing partial-thickness laceration

• forget the need to prepare the eye as if it were undergoing an intraocular procedure when a full-thickness suture is to be removed

Summary

The cornea is the most commonly injured ocular tissue. In most cases, pain is inversely proportional to significance. Full-thickness wounds are of major concern since they represent increased endophthalmitis and ECH risk. Improper treatment of the corneal injury can result in visual impairment because of several factors ranging from an unnecessarily prominent scar to vitrectomy delayed too long because of undue corneal edema. Scleral and corneal wounds have very different implications; this is discussed in Chap. 2.11.

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