Ophthalmology Surgical Pearls: Corneal Gluing and Suturing

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3 min read

Sit down with Dr. Rostov to gain a comprehensive overview of how ophthalmologists can perform corneal gluing and suturing.

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
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.

For a step-by-step guide to performing corneal gluing and suturing, watch the full video by Dr. Rostov!

  1. Sharma A, Sharma N, Basu S, et al. Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions. Clin Ophthalmol. 2023;17:209-223. doi:10.2147/OPTH.S394454
Audrey R Rostov, MD
About Audrey R Rostov, MD

Audrey Rostov, MD, is a cornea, cataract, and refractive surgeon who practices at Precision Vision of Bellevue and Seattle in Seattle, Washington. Dr. Rostov attended medical school at the Washington University School of Medicine in St. Louis, where she also pursued an ophthalmology residency. Subsequently, she went to the University of Minnesota for a cornea, external disease, and anterior segment surgery fellowship.

Dr. Rostov's specialties include: FLACS femtosecond laser-assisted cataract surgery, complex cases, bimanual microincisional cataract surgery, crosslinking and ICRS for keratoconus and corneal ectasia, femtosecond laser keratoplasty, SMILE, LASIK, refractive lens exchange, presbyopic IOLs, DMEK, DSEK, DALK, femto DALK.

Audrey R Rostov, MD
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