|Year : 2022 | Volume
| Issue : 3 | Page : 783-785
Role of compression sutures in partial-thickness corneal tears
Sahiti Puttagunta1, Sunitha Nagella2, Srinivas P Killani3
1 Department of Cornea, Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
2 Civil Assistant Surgeon, Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
3 Incharge of Cornea Department, Sarojini Devi Eye Hospital, Hyderabad; Professor, Department of Cornea, Government Medical College, Sangareddy, Telangana, India
|Date of Submission||03-Jan-2022|
|Date of Acceptance||16-Mar-2022|
|Date of Web Publication||16-Jul-2022|
Dr. Sahiti Puttagunta
H.No: 3-5-694/1, Flat No: 105, Samvai Towers, Behind Telugu Academy, Himayat Nagar, Hyderabad - 500 029, Telangana
Source of Support: None, Conflict of Interest: None
Ocular trauma is an important cause of unilateral vision loss worldwide. In cases of perforating corneal injuries, immediate surgical intervention is imperative to prevent endophthalmitis; however, in cases of partial-thickness corneal tears, conservative management usually suffices. However, intervention in the form of compression sutures may be required later for astigmatism that may arise.
Keywords: Compression sutures, ocular trauma, partial-thickness corneal tears
|How to cite this article:|
Puttagunta S, Nagella S, Killani SP. Role of compression sutures in partial-thickness corneal tears. Indian J Ophthalmol Case Rep 2022;2:783-5
|How to cite this URL:|
Puttagunta S, Nagella S, Killani SP. Role of compression sutures in partial-thickness corneal tears. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:783-5. Available from: https://www.ijoreports.in/text.asp?2022/2/3/783/351129
Ocular trauma is a major cause of unilateral vision loss worldwide. It can involve either full thickness of the cornea or partial thickness. Full-thickness corneal tears are to be repaired immediately, whereas partial-thickness tears can be treated conservatively, which later heals by fibrosis. In some cases, the healing process results in astigmatism for which intervention in the form of compression sutures is required to achieve an emmetropic state.
| Case Report|| |
A 43-year-old female patient presented to us with injury to the right eye with a bottle cap. Her visual acuity was counting fingers close to the face in the right eye and 6/6p in the left eye. On examination, there was a crescent-shaped partial-thickness corneal tear extending from a 2–11 o'clock position involving the pupil with stromal edema in the superior cornea between the tear and limbus [Figure 1]a. Seidel's test was negative. Partial-thickness corneal tears, when left alone without intervention, usually heal without causing any surface disturbance especially if there is a good tissue approximation. Moreover, suturing carries a risk of inducing astigmatism and acts as a nidus for infection. Taking these factors into consideration, we have decided to manage this case conservatively without suturing. In further follow-ups, much of the stromal edema subsided and after 1 month, her visual acuity in the right eye improved to 6/24. As a part of the normal healing process, there was fibrosis along the tear and the superior cornea showed a hypermetropic shift, which was confirmed by corneal topography [Figure 1]b. On retinoscopy, the corneal surface above the tear showed +8 D in horizontal meridian and +4.50 D in vertical meridian, whereas below the tear accepted +3 D in the horizontal meridian and +4 D in the vertical meridian. To prevent its progression and achieve emmetropization, three compression sutures were placed along the steepened areas (at 3, 6, and 9 o'clock positions) as guided by corneal topography [Figure 2]a. At 1-week post-op, corneal topography showed increased steepness adjacent to the sutures [Figure 2]b, hence two more compression sutures were placed at 5 and 8 o'clock positions [Figure 3]a. However, corneal topography still revealed localized corneal steepening at 8–9 o'clock position [Figure 3]b and hence one more suture was placed between 8 and 9 o'clock positions [Figure 4]a and [Figure 4]b. After 2 months, the sutures were removed [Figure 5]a. The patient was followed up and after 2 months, her uncorrected visual acuity was 6/12 P and the best-corrected visual acuity was 6/9 with –1.00 Dsph. Corneal topography showed uniform curvature of the cornea [Figure 5]b.
|Figure 1: (a) Partial-thickness corneal flap. (b) Corneal topography showing steepness along with the corneal tear|
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|Figure 2: (a) Three sutures placed along the steep meridians. (b) Corneal topography showing flattening along the suture meridians and steepening in the adjacent areas|
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|Figure 3: (a) Two more sutures were placed along the induced corneal steepening. (b) Corneal steepening between 8 and 9 o'clock positions|
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|Figure 4: (a) Suture placed between 8 and 9 o'clock positions. (b) Corneal topography after placement of five sutures corresponding to the improved refractive status of the patient|
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|Figure 5: (a) Cornea after suture removal. (b) Corneal topography after suture removal showing uniform corneal curvature|
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| Discussion|| |
Ocular trauma is one of the most important causes of avoidable vision loss all over the world. Ocular trauma involving the cornea can be penetrating type where there is a partial-thickness corneal tear with only entry wound or perforating type, which is a full-thickness corneal tear with both entry and exit wounds. In the presence of full-thickness corneal tears, prompt wound closure should proceed in a timely manner to decrease the risk of endophthalmitis and avoid tissue necrosis. However, in cases of partial-thickness corneal tears, surgical intervention is not always necessary. If the preoperative visual acuity is good and the laceration is self-sealing with good tissue approximation, placement of interrupted nylon sutures may result in more extensive fibrosis with decreased postoperative visual acuity and increases the chances of irregular astigmatism. Application of a soft bandage contact lens with concomitant use of topical antibiotics will frequently result in a better outcome than surgical intervention. In this way, most of the times recovery is uneventful. But sometimes, the micromechanical effects of a penetrating injury may alter corneal topography, requiring intervention later on in the form of compression sutures to control astigmatism as in our patient.
Compression sutures should be deep up to only 50–75% depth of the cornea because full-thickness sutures may allow suture material to act as a conduit for microbial invasion and subsequent endophthalmitis. Striae may be observed perpendicular to the area of the suture when appropriate tension is applied. If the sutures are too tight as evidenced on corneal topography, additional placement of sutures will be required later to achieve an emmetropic state as we did in our patient. If more than four seem to be needed, the compression sutures are either poorly placed or overly tight.
| Conclusion|| |
We conclude by stating that conservative management is the preferable approach to partial-thickness corneal tears in which the recovery is uneventful in most cases. Intervention in the form of compression sutures may be required later for astigmatism that may have been induced as a part of the healing process.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Macsai MS, Fontes BM. Trauma suturing techniques. In: Macsai MS, editors. Ophthalmic Microsurgical Suturing Techniques. Berlin, Heidelberg: Springer; 2007.
Macsai MS. The management of corneal trauma: Advances in the past twenty-five years. Cornea 2000;19:617-24.
Buzard KA. Compression sutures and penetrating corneal trauma. Ophthalmic Surg 1992;23:246-52.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]