Atlas of Ophthalmology

Wound Dehiscence After ECCE, Loose Sutures in Peripheral Corneo-scleral Incision Without Conjunctival Flap

Wound Dehiscence After ECCE, Loose Sutures in Peripheral Corneo-scleral Incision Without Conjunctival Flap
The patient had an extracapsular cataract extraction (ECCE). 5 days postoperatively he was noted to have a wound dehiscence secondary to loose sutures. Seidel test was negative. The applied type of corneoscleral incision usually leads to loosening of the sutures because the suture is not covered by conjunctival tissue like it would be with a fornix-based flap. The soft conjunctiva gives in and the suture loosenes. Slight pressure on the cornea would make the Seidel-test positive. The sutures hold well on Bowman's membrane but they loosen on the scleral side. Alternative options would have been a truly corneal incision or a fornix- or limbus-based conjunctival flap over a sclerocorneal incision. Advice for present situation: Woundrevision , 2-3 situation sutures, fornix-based conjunctival flap; cleaning of wound (presumably there is a vitreous strand which reaches from the peaked pupil to the periphery at 11 o'clock with damaged iris); 5 10-0-Nylon sutures broad in sclera and cornea and then 2 traction sutures to cover the wound with conjunctival flap.
Premsenthil, Mallika, M.D., Universiti Malaysia Sarawak¦2, Kuching, Malaysia
T81.3
Lens -> Postoperative Cases and Surgical Procedures
7848
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