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D. Levinsohn, C. Yu, J. Sokol, H. Engel; An Experimental Study of Ocular Trauma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4661. doi: https://doi.org/.
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The repair of traumatic rupture of the posterior globe is usually unsuccessful. Classical texts recommend precise end-to-end approximation of wound margins to achieve water-tight closure and maintenance of normal corneal curvature. Penetrating injuries of the retina with intraocular hemorrhage lead to inflammation and cell proliferation producing peri-retinal membranes and tractional retinal detachment (RD). Imbrication of the edges of the ruptured wound has been proposed as an alternative and simplified method of repair that may offer advantages in reducing postoperative tractional forces. Tissue adhesives may aid in achieving secure wounds. We compared imbricated v. end-to-end closure to evaluate the relative merits of repair of posterior wounds.
One eye only of 12 adult Dutch Belted rabbits was lacerated to make a horizontal 8.0 mm equatorial, full thickness wound 3 mm posterior to the limbus in the superortemporal aspect of the globe. Six of the rabbits’ eyes were repaired using four equidistant interrupted 8-0 Nylon sutures for end-to-end closure. The remaining six rabbits eyes were repaired using four 5-0 braided Dacron mattress sutures placed 1.0 mm from the wound edge for an imbricated closure. In eyes where a watertight seal could not be made by suturing alone, BioGlue was applied. On day 35, the eyes were examined by indirect ophthalmoscopy. The rabbits were then euthanized, enucleated, and the sutured eye prepared for staining. Optic nerve and pupil sections were prepared and stained with hemotoxylin and eosin, as well as Masson’s Trichrome.
No significant difference in wound healing was observed in eyes repaired by imbricated v. end-to-end suturing technique (Wilcoxon rank sum). None of the eyes developed a retinal detachment. Clinically, both sets of eyes exhibited minor degrees of scarring, membrane formation, and neovascular proliferation. Pathologic grading was equivalent.
In this model of posterior penetrating trauma, imbricated and end-to-end suturing resulted in equivalent outcomes.
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