This technique will avoid irritating the area with the 2 free ends left by a normal interrupted suture. Suturing technique remains one of the most vital skills in the art of contemporary corneal surgery. Surgical repair of corneal laceration complicated by iris. Effect on corneal shape of suturing the scleral wound during. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques. This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. Sutures and wound closure techniques introduction this booklet is intended as an introductory guide to sutures and suturing techniques. Surgical repair of corneal laceration complicated by iris inclusion in a dog exposure. These significant variations in practice need to be considered when interpreting outcomes and research. Oetting link to video to place 8 radial, 100 nylon sutures in clear corneal wounds place some sutures using the traditional technique and some using a reverse needle pass technique. The adhesions between the protruded iris thickness lacerations penetrate the chamber rapidly and cornea were gently separated and the iris was and may traumatize the intraocular structures and.
The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. The primary method to minimize astigmatism in the corneal graft postoperatively is to readjust or remove the sutures. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts. Improving corneal repair new polymers may help speed healing and prevent complicationswithout the downsides associated with existing options. In all, 68% of questionnaires were completed and returned. Macsai and bruno machado fontes 7 key points assess the presence of lifethreatening injuries. Several corneal suture techniques have already been described. Closer, shorter sutures are used centrally, avoiding the visual axis, to close the wound without excessive flattening fig 16. To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the united kingdom. Although the main purpose of suture placement remains adequate wound apposition and closure, meticulous attention to appropriate suture placement cannot only minimize postoperative astigmatism, but also may facilitate more rapid visual recovery and lead to a more stable wound long term. Final refining of technique prior to grading exercise in lab 4. Patients were followed up at 4 weeks, 3 months, and 6. We describe a surgical technique to manage persistent corneal striae after laser in situ keratomileusis lasik. Although suture materials and aspects of the technique have changed, the primary goals remain the same.
Suturing techniques and postoperative management in. Maguire, md, to residents at the university of iowa, october 20. May 01, 2007 several corneal suture techniques have already been described. Ophthalmic microsurgical suturing techniques part 6 doc. Days 15 vasoconstriction and platelet aggregation angiogenesis occurs in 48 hours poor tensile strength wound closure and healing dependent on suture and good approximation. Corneal lacerations and perforations represent a large percentage of ocular trauma cases, and quick diagnosis is important. To demonstrate the basic principles of suturing for the closure of cutaneous surgical wounds. Meyle suture materials and suture techniques figs 10a and 10b approximation of the wound edges after tooth extraction by overlying, crossedover mattress stitch.
Corneal sutures should be 90% deep in the stroma and of equal depth on both sides of the wound. We investigated the effects on corneal shape of suturing the scleral wound during 23gauge vitreous surgery. A randomized clinical trial was conducted to contrast two techniques of suturing in penetrating keratoplasty pk surgery. The long end of the suture is wrapped around the tip of the closed needle holder twice before grasping the short end of the suture with the needle holder. We used a corneal topographic modeling system to measure the corneal shape in 39 eyes of 39 patients before and at 1 week, 1 month, and 3 months after performing 23gauge vitreous surgery. Methods a postal questionnaire was sent to 7 ophthalmic consultants identified from a royal college of ophthalmology database as having a special interest in anterior segment surgery. Sequential lift and suture technique for postlasik corneal. The results in 10 eyes 9 patients showed complete resolution of striae with improvement in subjective symptoms glare and blurred vision and best. Evaluation of techniques of single continuous suturing in penetrating keratoplasty 5.
Suture knots should be buried in the corneal stroma, not in the wound. Methods 53 eyes of 53 patients underwent penetrating keratoplasty using torque 17 patients, antitorque 18 patients, and no torque 18 patients suturing techniques in this prospective study. Although the main purpose of suture placement remains ade. When the anatomy of the wound allows, a topographic closure is best for reducing longterm complications. In 15 richly illustrated chapters this book imparts basic information on tissue tactics and knot tying and demonstrates the applicability of these techniques to various.
In this series of videos, he discusses how to engineer the. The company was first in the world to broadcast live surgeries on the internet using its orlive solution which provides an intimate look inside the operating room. In sensitive areas, like a tongue laceration, use the interrupted sutures with buried knots. Patients were followed up at 4 weeks, 3 months, and 6 months. Ultrasound biomicroscopy confirmation of corneal overriding due to improper suturing of fullthickness corneal laceration. Deep suturing technique for penetrating keratoplasty.
Evaluation of techniques of single continuous suturing in. Fullthickness sutures may allow the suture material to act as a conduit for microbial invasion. Brightbill md clinical professor department of ophthalmology and visual sciences university of. Once the cardinal sutures are in place, a variety of suturing techniques can then be implemented. Certain anatomical areas like the retroauricular skin, are prone to wound inversion, and this is an indication for placing horizontal continuous mattress sutures. This study was undertaken in a wet laboratory environment using artificial eyes. Surgical treatment of corneal ectasia with motowas. Corneal suture for the correction of hyperopia following.
Know the needle type and suture type used for clear corneal wounds. Sequential lift and suture technique for postlasik. Cardinal suture placement largely determines fi nal corneal sphericity and subsequent corneal astigmatism. Jun 19, 2018 most common type of needle used for suturing sclera and tarsus. Rupp, md, is a glaucoma and advanced anterior segment surgeon in private practice at clarus vision clinic in salt lake city. A total of 2568 pk operations were undertaken in the united kingdom in 20082009. The task of 311 corneal suturing is sometimes used at the end of cataract surgery and in corneal graft surgery, but by no means is it universally used. In this series of videos, he discusses how to engineer the placement of a suture in a corneal transplant so that the length, depth, and radiality of the sutures are consistent around the. Cyclosporine a csa, monoclonal antibody antit cells, and a specific inhibitor of inducible no synthase alone or in a combination with csa were tested as immunosuppressants. Methods53 eyes of 53 patients underwent penetrating keratoplasty using torque 17 patients, antitorque 18 patients, and no torque 18 patients suturing techniques in this prospective study. Aimto evaluate the three techniques of single continuous suturingnamely, torque, antitorque, and no torque in penetrating keratoplasty. Corneal astigmatism after penetrating keratoplasty the role of suture technique david c.
Keep in mind that the knots may take a bit longer to resorb due to the increased amount of suture material left inside the wound. Corneal surgery fourth edition lead editor frederick s. Simple interrupted suture most simple suture to use and suitable for almost all situations needle is inserted in one side of the wound and out through the wound itself suture should extend through. Ophthalmic suturing 101 american academy of ophthalmology. Suturing techniques different types of suture with videos. In eye surgery, due to the lack of elasticity of the tissues and the influence of sutures on the visual outcome, proper microsurgical suturing technique is. Research department, king khaled eye specialist hospital, riyadh, saudi arabia 2 cornea and anterior segment division, king khaled eye specialist hospital, riyadh, saudi arabia.
Each technique has its own advantages and disadvantages, and suturing technique is perhaps the area of greatest variation in pk surgery. Ophthalmic microsurgical suturing techniques marian s. Ophthalmologists are well aware that incision location and. Corneal suturing, part 1 a curriculum for suturing the cornea. Surgical treatment of corneal ectasia with motowas trephine and selective suturing technique saeed almotowa 1, mosa alharby 2 1 cornea and anterior segment division. Ophthalmic microsurgical suturing techniques is a reference text for both the novice and the accomplished ophthalmic surgeon. Aim to evaluate the three techniques of single continuous suturingnamely, torque, antitorque, and no torque in penetrating keratoplasty. Mannis 6 key points g suical r ndicai tions congenital corneal disorders corneal dystrophies corneal degenerations corneal scarringopacifi cation infection infl ammation trauma graft failure corneal decompensation pseudophakic aphakic. In 15 richly illustrated chapters this book imparts basic information on tissue tactics and knot tying and demonstrates the applicability of these techniques to various microsurgical situations, in both the anterior and the posterior segment of the eye.
Most common type of needle used for suturing sclera and tarsus. Aug 15, 2012 the questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts. Rupp completed his residency and fellowship training at washington university in st. Whilst sutures create conditions for primary healing, inappropriate selection and technique can have an adverse effect by increasing infection risk, impairing local circulation or causing further tissue injury. Macular corneal dystrophy 1 1 1 congenital hereditary endothelial dystrophy 0 1 0 bullous keratopathy after trauma 1 0 0. From the editor our topic this month is eyesspecifically corneal transplants. Pdf ophthalmic microsurgical suturing techniques 2007. A variety of suture fi xation patterns can be imple mented for appropriate tissue alignment and wound closure. Effect of suturing technique on corneal xenograft survival. May 03, 2020 corneal lacerations and perforations represent a large percentage of ocular trauma cases, and quick diagnosis is important. This chapter is about basic surgical principles and techniques, and how a delicate. Basic suturing skills and techniques boston college.
Cornea the impact of corneal suture by matt young eyeworld contributing editor sutures, like the ones used here in conjunction with trabeculectomy, are sometimes necessary in ophthalmic surgery. In addition to the basic options, this guide see tables and slideshow below will also discuss some basic suturing techniques that will help you develop your skills regardless of the tissue youre working with. Dr todd gunson, dermatology registrar, greenlane clinical centre, auckland, new zealand, 2008. Two or three further single throws are then added in a similar fashion to secure the knot. Vision at the time of presentation and the presence or absence of aff erent pupillary defect are important prognostic factors in the ocular trauma classifi cation system 1. If a single running suture technique has been used, the surgeon may redistribute the suture tension at 1 month postoperatively using corneal topography as a guide. Open access full text article suturing techniques and. We investigated the immediate postoperative changes and the postoperative changes over. Closing dead space supporting and strengthening wounds until healing increases their tensile strength approximating skin edges for an aesthetical. Integrating the steps into a whole for more than 20 years, broadcastmed has been innovating digital strategies for healthcare organizations. The effect of different suturing techniques on astigmatism. To learn the basics of suturing prior to trying these out click here.
Busin m, monks t, alnawaiseh i 1998 different suturing techniques variously affect the regularity of postkeratoplasty astigmatism. In surgery suture is the act of sewing or bringing tissue together and holding them in. Pdf suturing techniques and postoperative management in. Pdf amniotic membrane suturing techniques researchgate. Mar 05, 2020 as a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Suturing and tying techniques as presented by leo j. The sequential lift and suture technique reduces the time required for lasik, eliminates the need to fixate the flap with forceps during suturing, and increases the accuracy of suture placement.
In this chapter, we describe the traditional suturing techniques to secure am to the ocular surface. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Part of that skill set involves deciding which suture to use. Corneal suturing, part 1 a curriculum for suturing the cornea duration.
Whether corneal wounds happen by accident or are part of surgery, helping them to heal quickly and safely without inducing astigmatism has always been the surgeons goal. To obtain the best results, it is important to have good quality instruments that are the correct size for the location and nature of the wounds. Sutures were left either as long or as short as possible to limit the extent of a nonspecific inflammatory response. If watertight closure of the wound proves difficult to achieve because of unusual laceration configuration or loss of tissue, xshaped or pursestring sutures or other customized techniques may suffice. There were 47,530 corneal transplants performed in the u. This technique is used to suture tubular structures such as blood vessels in order to stop bleeding or reestablish blood flow horizontal continuous mattress sutures. Evaluating surgical dexterity during corneal suturing. Results in all, 68% of questionnaires were completed and returned. Corneal transplantation is a surgical procedure in which a damaged or diseased cornea is partially or entirely replaced by donated corneal tissue from a recently deceased person. Patients with combined cataract or glaucoma surgery, corneal scarring including peripheral cornea, and the subject who underwent therapeutic keratoplasty for infectious keratitis were excluded at the beginning of study. Study 37 terms chapter 16 ophthalmic surgery flashcards. Fullthickness corneal transplant procedure aimed at making a fullthickness resection of the patients cornea, followed by placement of a fullthickness donor corneal graft.
As a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Effect on corneal shape of suturing the scleral wound. Widerspaced, longer sutures are used in the peripheral cornea to flatten locally and steepen centrally. Th e interrupted suture technique should be performed in all cases of pediatric keratoplasty, traumatic or spontaneous graft dehiscence repair, tectonic keratoplasty, and.
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