Welcome back to Interventional Mindset, in this episode, Audrey R. Rostov, MD, reviews surgical pearls for performing corneal gluing and suturing.
Dr. Rostov is a cornea, cataract, and refractive surgeon who practices at Precision Vision of Bellevue and Seattle in Seattle, Washington.
When to perform corneal gluing or suturing
A question that comes up regularly from physicians new to corneal gluing or suturing is how to identify which procedure is appropriate for a corneal laceration or perforation, noted Dr. Rostov.
Generally, she recommended opting for corneal gluing if a perforation is:1
- Less than 2mm
- Descemotecele
- Sterile (e.g., a complication of rheumatoid arthritis)
Dr. Rostov also discussed where sterile corneal perforations tend to be located, and which collagen vascular and autoimmune diseases physicians should consider when conducting a workup for patients with unexplained, sterile corneal perforations.
Guide to corneal gluing for small corneal perforations
Dr. Rostov outlined step-by-step how she performs corneal gluing, including:
- How to assess the area of perforation
- Where to perform the procedure
- How to prep patients for corneal gluing
- What kind of corneal glue to use
- How to place the corneal glue on the perforation
- How much glue to use and how to trim the glue if an excess amount is applied
- Post-operative management
- When to follow up with patients
Corneal suturing for lacerations or larger perforations
Next, Dr. Rostov described her preferences for performing corneal suturing for larger lacerations or perforations, such as:
- How to assess the wound and considerations for lacerations caused by trauma
- Which kind of anesthesia to use for large and partial-thickness corneal lacerations
- Which type of sutures she uses
- Where to place the sutures and what size bites to use
- When to use a mattress suture
- How to check for sufficient wound apposition
- Why she uses a slip knot technique for corneal sutures
Combining corneal suturing and gluing
In the rare case of a corneal wound that has already been sutured but continues to leak, after checking for good wound apposition, Dr. Rostov noted that surgeons could consider adding glue as well with a 27- or 30-gauge needle to help seal the perforation.
Conclusion
Corneal perforations can be managed with a variety of treatment approaches;1 it is important that ophthalmologists are familiar with how to assess, stratify, and treat corneal wounds using appropriate techniques.
