A case of a 9 year old boy who came to the emergency after injury with his own glass spectacles.
The tear extended from 5 o clock to 10 o clock with a curved pattern. The uveal tissue was prolapsed.
He was immediately taken up for primary wound closure.
-Full thickness corneal lacerations of more than 2mm require to be sutured to close the wound.
-The needle should enter the cornea perpendicular to the tissue when passing a suture.
-Sutures should be passed at 90% depth in the stroma because too shallow can lead to posterior wound gape.
-Full-thickness passes can become a track for microorganisms to enter the eye.
-The suture is tied with a slip knot (3-1-1).
-Compression zones: triangular extensions from the suture, to ensure there are no gaps.
-Long sutures will have a large zone of compression compared to shorter sutures.
-Long sutures should be passed in the periphery to steepen the cornea centrally and seal the wound.
-Centrally the sutures are in the visual axis.
-Placing short sutures centrally with minimal suture tension will reduce astigmatism and prevent excess scarring.
-When there is a tissue prolapse, it has to be reposited back into the eye before suturing.
-Create a paracentesis away from the wound inject viscoelastic.
-Use a cyclodialysis spatula to pull the iris back into the eye through a sweeping motion.
-Sutures have to be buried to hide the knot.
www.ophthalmobytes.com
way too many sutures here. Significantly few sutures would have also sufficed without any compromise of safety.