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Alice Lorch, Peter Veldman; Examination of Corneal Anatomy in Attempted Ninety Percent Depth Suture Repair of Traumatic Corneal Lacerations, Utilizing Post-Operative High Resolution Anterior Segment OCT Imaging. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3871.
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To assess suture placement and the anatomic restoration of corneal anatomy in attempted 90 percent depth (partial thickness) suture repair of corneal lacerations, utilizing post-operative anterior segment OCT imaging.
Five patients with attempted 90 percent suture depth repair of traumatic corneal lacerations were examined with high resolution anterior segment OCT following open globe repair. Included patients sustained Zone 1 open globe injuries that were repaired by the MEEI trauma service using standard partial thickness suturing technique. Imaging of the cornea utilizing high-resolution anterior segment OCT was performed cross-sectionally over each corneal suture within one week of repair. Primary outcomes included depth of each corneal suture (%) on each side of the wound, endothelial misalignment at each suture (microns) and difference in corneal thickness between each side of the wound (%) in instances of this misalignment.
Anterior segment OCT of corneal sutures in one pilot patient revealed a wide range of depths from 50% to full thickness. In one illustrative pass, the corneal suture depth was 55% on one side and 42% on the other side of the wound, with 135 microns of misalignment of the endothelium. The cornea thickness on the side of the wound with stromal exposure was 9% increased. Analysis of all included patients in this study is pending.
Despite the high frequency of corneal laceration repairs after trauma, there are no studies examining the post-operative anatomy of attempted partial thickness sutured corneal repair. This study serves to establish a baseline regarding the actual depth of these sutures in a series of patients with traumatic corneal lacerations. It also serves to examine the degree of endothelial misalignment, and subsequent edema due to stromal exposure, in these attempted partial thickness closures. This is significant because corneal edema after laceration repair can hinder post-operative monitoring and treatment of posterior segment pathology and may lead to penetrating keratoplasty or keratoprosthesis to facilitate timely retinal surgery when indicated. This study is the first to utilize high resolution imaging techniques to establish these baseline characteristics of attempted partial thickness cornea repair in ocular trauma.
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