Corneal sutures: Is routine removal really necessary?

Abstract

SUMMARYThree groups of patients were reviewed 1,2 and 3 years after extracapsular cataract extraction to assess the inci dence of problems related to nylon corneal sutures and the need for suture removal. A large percentage of patients were found to have suture-related problems and required or had previously undergone suture removal.These findings are analysed. The potential risk of sight threatening pathology associated with corneal sutures that are left in situ suggests that routine suture removal about 3 months after surgery is to be recommended. Jackson and Bosanquet" reported that a high percentage of patients whose sutures had not been removed had suture-related problems after the first year. We have tried to appraise the overall trends related to the problems asso ciated with corneal sutures in order to establish whether early routine removal is to be recommended. PATIENTS AND METHODSOne hundred and eighty patients (three groups of 60) who had undergone extracapsular cataract extraction 1, 2 or 3 years previously were invited to attend for review. A cor neal section had been performed on all patients and 10/0 nylon sutures (interrupted or continuous) used for closure.One hundred and fifty-eight patients attended and were RESULTSPatients reviewed were subdivided into groups according to their symptoms and the condition of their corneal sutures. Those who had had their sutures previously removed were grouped separately. Table I shows the breakdown for each year group. This information is illustrated graphically in Fig. 1. Abnormal physical signs attributable to loose or broken sutures were also recorded (Tables II, III After the second and third post-operative years this had risen to 72.2% and 87.5% respectively. The chi-squared test for trend is significant at p<O.OO 1.A further 4.2% of patients were found, after 3 years. to have absent sutures -presumably as a result of progres sive degradation. One would anticipate that a proportion of patients in the latter group would have had a broken or loose suture remnant at some stage.Only 8.3% of patients had an intact suture after 3 years

Suture-related corneal infections after clear corneal cataract surgery

“…The only 2 related studies 8,11 report corneal infections leading to endophthalmitis after extracapsular cataract surgery. In addition, Kehdi et al 14 and Cosar et al 15 report a combined 12 patients with corneal wound infections after sutureless clear corneal cataract surgery.…”

“…Three years after cataract surgery, 88% to 90% of sutures are broken or loose. 8,9 When loose or broken sutures are removed after cataract surgery, about 40% will demonstrate bacterial contamination. 10 The potential morbidity associated with suture-related infections is illustrated by a case series of 4 patients who developed endophthalmitis after extracapsular cataract extraction with PC IOL implantation.…”

Post-operative astigmatism control by selective suture removal

“…We do not feel that routine removal of all sutures at 12 weeks, as suggested in a recent study, is justified because we have demonstrated that there can be a significant change in astigmatism by suture removal as late as 25 weeks following surgery. 9 We also feel that the prescription of spectacles should be delayed for 1 week after final suture removal. This not only allows rapid visual rehabilitation for the patient, but enables the ophthalmologist to ensure that the residual astigmatism is sufficiently small for spectacles to be prescribed.…”

Suture-related complications after congenital cataract surgery: Vicryl versus Mersilene sutures

“…Nylon sutures have a high incidence of complications after cataract surgery because they degrade. [1][2][3][4] On the other hand, monofilament polyester sutures (Mersilene) do not hydrolyze or disintegrate and have proved to be superior to nylon in adults. Nevertheless, Mersilene sutures may cause severe adverse effects that necessitate their removal.…”