Corneal Laceration Repair Research Articles

Novel Technique to Close Stellate Corneal Lacerations.

The study was performed to evaluate and optimize a novel technique to close stellate corneal lacerations in a wet laboratory environment. Twenty-one ex vivo porcine eyes with standardized, experimentally created stellate corneal lacerations were assigned to one of three surgical repair techniques. In Group 1 (n = 9), lacerations were closed with simple interrupted sutures only. In Group 2 (n = 7), a large-radius central purse string was used in addition to simple interrupted sutures. In Group 3 (n = 5), a small-radius central purse string was used in addition to simple interrupted sutures. Wound stability was assessed by determining the intraocular pressure (IOP) at which wound leak occurred. Group 3 eyes demonstrated a mean wound leak IOP of 56.1 mm Hg (range 32-90.3) compared with groups 1 and 2, which demonstrated mean wound leak IOPs of 6.4 mm Hg (range 1.9-19) and 13.3 mm Hg (range 2.8-31), respectively. These differences were highly statistically significant (P<0.002 and P<0.015, respectively, compared with Group 3). The use of a small-radius internal purse-string suture, when combined with simple interrupted sutures, produced a highly effective watertight closure in experimentally created stellate corneal lacerations, significantly outperforming approaches using only interrupted sutures or a large-radius purse string. The use of a small-radius purse-string suture should be considered for clinical use in the repair of stellate corneal lacerations.

Imaging Mismatch of Nail in the Eyeball: What’s next?

Introduction : A retained foreign body (FB) can lead to severe complications, the most devastating of which is eye loss. We present a discrepancy of imaging that resulted in a dilemma in the approach management of a mixed global-adnexal FB case.&#x0D; Case Illustration : A 31-year-old man came to the emergency room with blurry vision for 1.5 hours after a nail hit his right eye (RE). The visual acuity of RE is light perception. Ophthalmological examination revealed a central Y-shaped full-thickness corneal laceration with iris and vitreous prolapse. The lens appeared cloudy, and the posterior segment was difficult to assess. Imaging showed a foreign metal object asa nail in the oculi to intraconal without penetration to the orbital wall. He was planned to undergo FB extraction with corneal laceration repair and aspiration of lens mass irrigation. However, the nail was hard to find intraoperatively because the vitreous and choroid kept coming out. Hence evisceration with DFG was performed. The nail was found more posteriorly and attached to the bone.&#x0D; Discussion : While primary repair is the standard practice for open globe injury, managing retained intraocular metallic foreign bodies is controversial. Imaging such as CT scans can help determine the location of FB and approach management. In this case, imaging showed the FB was in the iris plane and not penetrating the orbital wall, so primary repair and FB extraction were planned.&#x0D; Conclusion : The imaging may not always be accurate in determining the exact location of FB, and the surgical approach may need to be adjusted accordingly.

Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India.

To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.

Modified technique for corneal laceration repair using amniotic membrane

Background Water-tight closure of lacerated corneal wounds may require a lot of sutures and result in significant corneal scarring and irregular astigmatism. Aim The aim of this study was to describe the technique of amniotic membrane (AM) onlay strip for corneal lacerations repair and to evaluate its outcome. Patients and methods This is a retrospective case series that included eight eyes with traumatic corneal lacerations. A strip of AM was applied to the corneal surface to cover the wound which was then sutured with 10/0 Nylon sutures involving the membrane. The sutures were well-spaced, and the suturing was avoided in the visual axis. Average keratometric (K) reading, keratometric astigmatism (KA), manifest refractive astigmatism (RA) in diopters (D), and spectacle or soft contact lens best corrected visual acuity (BCVA) were assessed 2 months after suture removal. Results Transient postoperative hypotony was encountered in five cases (62.5%). The average K was 44.61±2.81 D, KA 2.20±0.71 D, and RA 1.78±0.73 D (range=1–3 D). The postoperative LogMAR BCVA was 0.39±0.18 (range=0.22–0.70). Conclusions The application of AM inlay strip during repair of corneal lacerations was associated with good visual outcome possibly due to the reduction of wound and suture related corneal astigmatism.

Triple Procedures for Mechanical Ocular Trauma

Introduction: Mechanical ocular trauma is a major cause of ocular morbidity and can lead to severe visual loss. One of the most complicated mechanical ocular trauma is iridodialysis. In this case, we report three surgical procedures to treat the effect of mechanical ocular trauma. Case Presentation: A 32-year-old man was referred to Gatot Soebroto National Army Hospital, Jakarta, with major complaints of pain and blurred vision in the left eye after sustaining blunt trauma while playing tennis two days ago. He was diagnosed with postoperative corneal laceration repair, subtotal iridodialysis, traumatic cataract, and vitreous hemorrhage on his left eye. He underwent iridodialysis repair with the McCannel suture technique and continued with a pars plana lensectomy to remove the lens and a pars plana vitrectomy to treat the vitreous hemorrhage. Postoperative examination showed a significant improvement of best-corrected visual acuity (BCVA) from hand movement to 0.15 and no sign of acquired infection. Conclusions: The effect of mechanical ocular trauma might be unpredictable and may include various conditions. Accurate management will prevent further complication and improves the patient’s quality of life. A good approach and visual result will satisfy both patients and doctors.

Analysis of Operated Patients with Ocular Trauma: A 10-Year Retrospective Study.

Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs on the patient and the community. The present descriptive cross-sectional and retrospective study includes all patients with ocular trauma who underwent surgery in the referral center's ophthalmic operating room for 10 years. A checklist was completed for each patient, including demographic information and the variables required for the study. A total of 927 patients who underwent eye surgery due to ocular trauma were eligible for the study. All descriptive data were reported as the mean plus standard deviation for quantitative variables and distribution tables and frequency percentage for qualitative variables. Inferential tests such as independent t-test and Chi-square test were used to evaluate the research questions. This study showed that most ocular traumas occur at a young age and mostly in males. The types of trauma in the studied eyes were divided into penetrating and non-penetrating in different age groups. The results showed that the most common type of surgery was corneal laceration repair, and in all patients, visual acuity improved significantly after surgery. In this study, a total of 81% of patients underwent only one operation. Training and caring for children and adolescents about high-risk behaviors and educating industry professionals to wear goggles, and increase workplace safety can reduce these types of trauma.

Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients.

Purpose:To detect the presence of SARS-CoV-2 in aqueous and vitreous humor of COVID-19 patients in a pilot study.Methods:Consecutive patients planned for emergency ophthalmic surgeries after ocular trauma were subjected to naso-oropharyngeal RT-PCR test for SARS-CoV-2. Laboratory-confirmed cases were enrolled for the study. During surgery, 0.1 mL aqueous and vitreous each was aspirated. The vitreous tap was collected on clinical suspicion of endophthalmitis. RT-PCR test was used to detect SARS-COV-2 nucleotide in the samples. Cycle threshold (Ct) for E gene of ≤35 along with confirmatory results on one of the two target genes (RdRp or ORF1b) was considered as positive.Results:One hundred and thirty two patients were found positive on naso-oropharyngeal RT-PCR test for SARS-CoV-2 preoperatively. Seven patients with ocular trauma were studied. The mean age was 31.8 years. There were six male and one female patient. Two patients had symptoms of mild COVID-19 disease and the rest were asymptomatic. The mean Ct value of the E gene on naso-oropharyngeal RT-PCR was 23.14 ± 4.7. Corneal and corneoscleral laceration repair was done in five patients, intracorneal wooden foreign body was removed in one patient, and injection of intravitreal antibiotics was done in one patient. Aqueous and vitreous tap was collected in 7 and 5 patients, respectively. None of the aqueous or vitreous samples was found positive for SARS-CoV-2.Conclusion:SARS-CoV-2 was not detected by RT-PCR in aqueous or vitreous humor in this pilot study. Future studies with a larger sample size are needed to further explore the presence of SARS-CoV-2 in intraocular fluids.

Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model.

Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design Prospective randomized controlled trial. Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for "refresher" training. Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

A case report of fulminant endophthalmitis caused by Streptococcus dysgalactiae in a patient with traumatic corneal laceration

BackgroundTo report a case of enucleation caused by Streptococcus dysgalactiae endophthalmitis after traumatic corneal laceration.Case presentationA 69-year-old man with history of retinal detachment treated with vitrectomy and subsequent cataract surgery presented with traumatic corneal laceration while cutting grass. Appropriate repair of corneal laceration and intravitreal antibiotics (vancomycin, ceftazidime) injection was performed. S. dysgalactiae which was sensitive to the conventional antibiotics (Ampicillin, Ceftriaxone, Levofloxacin, etc.) detected by aqueous culture. One day following primary closure, the patient developed a complete hypopyon and vitreous membranes. Despite vigorous systemic and intravitreal antibiotics administration with vitrectomy, endophthalmitis was not controlled and patient’s ocular pain was increased. The vitreous culture was also positive for S. dysgalactiae. Finally, total enucleation was performed 9 days after trauma due to fulminant endophthalmitis with severe scleritis.ConclusionProgression of traumatic endophthalmitis associated with S. dysgalactiae can be fulminant. Sufficient warning to patient about enucleation and intensive care is needed in the case of this infection.

Microscope-integrated Intraoperative Optical Coherence Tomography for Anterior Segment Surgical Maneuvers.

PurposeTo evaluate the potential value of microscope-integrated optical coherence tomography (MI-OCT) in anterior segment surgical maneuvers.MethodsTwenty-four ophthalmology residents, who were randomly and evenly divided into two groups, performed four anterior segment surgical maneuvers (corneal tunnel, scleral tunnel, simple corneal suture, and corneal laceration repair) on porcine eyes with (group B) or without (group A) real-time MI-OCT feedback. All residents performed the maneuvers again without MI-OCT.ResultsCompared with group A, group B (with MI-OCT) showed better accuracy in the length/depth of the corneal tunnel and the length of the scleral tunnel. However, both groups showed similar performances in the depth of both the simple corneal suture and the corneal laceration suture. When both groups performed the maneuvers again without MI-OCT, group B still showed better results than group A for the length of both the corneal and scleral tunnels.ConclusionsPrimary results suggest that real-time MI-OCT images are valuable for some anterior segment surgical maneuvers and could be helpful in surgical training.Translational RelevanceMI-OCT systems can be valuable in improving accuracy and decision making during anterior segment surgery and will be useful in surgical training.

Visual Outcome of Corneal Laceration Repair in a Tertiary Hospital, Southwestern, Nigeria

Visual Outcome of Corneal Laceration Repair in a Tertiary Hospital, Southwestern, Nigeria

Collagen cross-linking as an adjunct for repair of corneal lacerations: a cadaveric study

ObjectiveTo determine the efficacy of collagen cross-linking (CXL) as an adjunct to suturing in the repair of corneal lacerations. MethodsA cadaveric study was undertaken in which a linear 5 mm corneal laceration was created in the central cornea of 20 eyes. The eyes were then randomized to receive 1 (n = 8), 2 (n = 8), or 3 (n = 4) standard corneal sutures. The burst pressure of the wound was then measured. All eyes in the 1- and 2-suture group then underwent standard CXL, with burst pressure repeated afterward. ResultsThe initial wound burst pressure in the 1-, 2-, and 3-suture groups was 54.9, 74.0, and 201.2 mm Hg, respectively. After CXL, wound burst pressure increased by a mean of 3.2 and 62.3 mm Hg in the 1- and 2-suture groups, respectively. This change was statistically significant in the 2-suture group (p = 0.017). After CXL, the 2-suture group still had a significantly lower burst pressure compared with the 3-suture group (p = 0.011). ConclusionsThe study highlights a potential novel application for CXL to strengthen corneal wounds. Provided that suture density is sufficient to appose the wound edges, CXL may result in short-term wound strengthening. This could potentially allow for decreased corneal suture density and a corresponding decrease in suture-related complications.

Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes.

PurposeThe integration of swept-source optical coherence tomography (SS-OCT) into the operating microscope enables real-time, tissue-level three-dimensional (3D) imaging to aid in ophthalmic microsurgery. In this prospective randomized controlled study, we evaluated the impact of SS microscope-integrated OCT (MI-OCT) on ophthalmology residents' performance of ophthalmic microsurgical maneuvers.MethodsFourteen ophthalmology residents from a single institution were stratified by year of training and randomized to perform four anterior segment surgical maneuvers on porcine eyes with (MI-OCT+) or without (MI-OCT−) direct intraoperative OCT guidance. Subsequently, both groups repeated the same maneuvers without MI-OCT feedback to test whether initial MI-OCT experience affected subsequent surgical performance. Finally, the MI-OCT− group was crossed over and allowed to repeat the same maneuvers with direct MI-OCT guidance. Each resident completed a survey at the completion of the study.ResultsWith direct MI-OCT feedback, residents demonstrated enhanced performance in depth-based anterior segment maneuvers (corneal suture passes at 50% and 90% depth and corneal laceration repair) compared with the residents operating without MI-OCT. Microscope-integrated OCT+ residents continued to outperform the controls when both groups subsequently operated without MI-OCT. For clear corneal wound geometry, there was no statistically significant effect of MI-OCT as applied in this study. Overall, the resident surgeons rated their subjective experience of using MI-OCT very favorably.ConclusionsMicroscope-integrated OCT feedback enhances performance of ophthalmology residents in select anterior segment surgical maneuvers. Microscope-integrated OCT represents a valuable tool in the surgical education of ophthalmology residents.

A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

Purpose:To compare intraocular pressure (IOP) measurements by rebound tonometry (Icare PRO; Icare Finland Oy, Helsinki, Finland) to measurements by indentation tonometry (Pneumotonometer Model 30 classic and Tono-Pen XL; Reichert, Buffalo, NY, USA) in supine sedated children with glaucoma.Methods:Prospective comparative observational study of Saudi Arabian children with glaucoma undergoing chloral hydrate sedation for ophthalmic examination (February 2012 - February 2013). Nonglaucomatous eyes were included as controls. Eyes with corneal scars or prior corneal transplant or lamellar surgery were excluded.Results:Fifty-two eyes (26 OD, 26 OS) of 28 children were included. Thirty-six eyes had glaucoma (32 primary congenital glaucoma, two Sturge-Weber related, and two aphakia related). Sixteen eyes did not have glaucoma (six with pediatric cataract, five normal eyes, two strabismic eyes, two eyes with simple megalocornea, and one eye had peripheral corneal laceration repair. In the glaucoma group, the mean IOP was 17.55 ± 5.97 mmHg (range, 8-31.5 mmHg) with the Icare PRO and 20 ± 6.4 mmHg (range, 8-35.5 mmHg) with the Pneumotonometer from 20.47 ± 6.81 mmHg (range, 10-43 mmHg) with the Tono-Pen XL. The Icare PRO readings were significantly lower than each of the indentation tonometers. For the control group, there was no statistically significant difference in IOP measured by the Icare PRO and the indentation tonometers.Conclusions:In this population of supine sedated children with glaucoma, IOP measurements with the Icare PRO tend to be lower than readings from the Pneumotonometer and Tono-Pen XL.

Controversies in ocular trauma classification and management: review

Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.

Surgical repair of corneal laceration complicated by iris inclusion in a dog

The prolapsed iris through a corneal perforation shallow anterior chamber with hyphema, miosis and is frequently encountered in small animal practice. dyscoria. The pupil was found to be distorted in the The condition may occur following progression of direction of corneal laceration. The physiological complicated corneal ulcers [1] or as a result of full parameters were within the normal range and the thickness corneal lacerations [2]. A prolapsed iris prolapsed iris tissue appeared to be fresh. Hence should be treated as an ocular emergency and requires surgical iris reposition and corneal wound repair under immediate surgical intervention for better prognosis. general anaesthesia was resorted too. The surgical repair usually involves correct reposition Treatment of viable iris tissue or excision of the incarcerated tissue, as well as adequate closure of corneal wound Topical instillation of 1% atropine sulphate [3]. The different corneal bandaging techniques using ophthalmic solution was done prior to surgery to contact lenses, collagen based biomaterials, cyano- achieve mydriasis. Pre-operatively, ceftriaxone acrylate tissue adhesives, corneal graft, third eye lid sodium was administered at the rate of 25 mg/kg body flap, conjunctival flap and temporary tarsorrhaphy for weight intravenously. The dog was premedicated with the repair of full thickness defect in cornea has also atropine sulphate at the rate of 0.045 mg/kg body been described [4]. However, traumatic prolapse of iris weight followed by xylazine hydrochloride at the rate and its surgical repair are less frequently documented. of 1.5 mg/kg body weight, both given intramuscularly. This paper presents a case of corneal laceration General anaesthesia was induced with ketamine complicated by iris inclusion in a dog and its surgical hydrochloride at the rate of 5 mg/kg body weight, repair using collagen sheet prepared from bovine administered intramuscularly. Anaesthesia was mainsmall intestine submucosa adjunct to corneal suturing tained by intravenous infusion of a combination of after iris reposition. xylazine hydrochloride and ketamine hydrochloride, equal quantity by volume and diazepam, given 'to Case History and Clinical Observations effect' along with 5% dextrose saline. The periocular A six month old male non-descript dog was area was carefully clipped and scrubbed with presented to the Veterinary College Hospital, povidone iodine solution diluted with normal saline Mannuthy with the complaint of a dark brown colored (0.2%). The corneal and conjunctival surfaces were mass protruding out from the right eye. History irrigated with isotonic balanced salt solution and the revealed trauma by a sharp object four hours ago. The periocular area was painted with povidone iodine animal was dull and depressed. On clinical solution. The dog was positioned in left lateral examination, the mass was found to be iris, which got recumbency with the eye placed under the objective entangled in the perforated cornea at 10 O'clock lens of the operating microscope (10x). Povidone position (fig. l). The dog showed epiphora, severe iodine (5% w/v) was instilled and the face was draped. blepharospasm and photophobia. Ophthalmic The Castroviejo lid speculum was applied for better

Long-term follow-up and visual outcome after excision of a traumatic iris cyst by viscoelastic dissection

To report the long-term follow-up and visual outcome after excision of a traumatic iris cyst. A 4-year-old female presented with an iris cyst in her left eye 2years after corneal laceration repair. An 8×7mm cyst was located between 1 and 6 O'clock on the iris, extending into the anterior chamber. The cyst was surgically removed by dissection from the endothelium and angle by viscoelastic and was submitted for histopathological examination. Postoperative outcomes including visual acuity (VA) and complications over 8years are reported. Histopathological examination demonstrated fragments of iris tissue extensively covered by a layer of epithelial cells which were present on both the anterior and posterior surfaces of portions of the iris stroma. 8years post-excision, the patient's VA improved from 20/80 to 20/30 with no evidence of recurrence and no adverse sequelae. Traumatic iris cyst is a diagnostic and therapeutic challenge for ophthalmic surgeons with an overall poor visual prognosis if it is not excised properly. Improved wound management techniques during the repair of a traumatic wound are highly recommended. Careful viscoelastic dissection of the iris cyst from the endothelium and angle provided acceptable long-term outcome and prevented recurrence.

Occult Perforating Corneal Injury from Mechanical Pencil Graphite.

An 11-year-old boy was struck in the left eye with a mechanical pencil in a projectile manner. Initial examination under the operating microscope revealed a presumed partial-thickness corneal injury with a retained 8-mm long segment of graphite lead. After removal of the graphite segment, a full-thickness hole in the cornea was revealed under the lead shaft. The proposed mechanism of injury and unique presentation was initial full-thickness penetration followed by lead shaft retraction (likely due to eye rubbing) and then corneal stromal reentry with stromal lamellar dissection and fixation. Prompt removal of the foreign body, corneal laceration repair, and early cataract extraction resulted in postoperative 20/40 uncorrected visual acuity. Mechanical lead pencil injuries represent a unique mechanism of penetrating trauma.

Comparison of Sutures and Dendritic Polymer Adhesives for Corneal Laceration Repair in an In Vivo Chicken Model

To compare clinical and histologic healing of corneal lacerations repaired by sutures or a new polymeric adhesive. A central full-thickness 4.1-mm laceration was made in the right eyes of 60 white leghorn chickens. Half of the wounds were treated with biodendrimer polymer adhesive and half were closed with 3 interrupted 10-0 nylon sutures. Slitlamp examination was performed at 6 hours, daily for 7 days, and weekly for 21 days. Animals were humanely killed at days 1, 3, 7, and 28 for histologic examination to evaluate corneal healing. Histologic observations on days 1, 3, and 7 showed glued wounds filled with fibrin, then hyperplastic epithelium, and subsequently scar tissue. Scarring was more prominent at day 7 in glued corneas; however, by day 28, sutured corneas exhibited more inflammation and scarring and much more irregular anterior corneal surfaces. Clinically, all glued corneas remained clear while nearly all sutured corneas had some degree of corneal scarring persisting through day 28. The procedure was about 5 times faster with sealant than with sutures. Corneal lacerations treated with adhesive heal favorably compared with sutures. Biodendrimer adhesives represent a safe, effective, and technically easier alternative to traditional suture repair of corneal perforations.

Feasibility of telerobotic microsurgical repair of corneal lacerations in an animal eye model

We evaluated the feasibility of telerobotic microsurgical repair of corneal lacerations. The telerobotic microsurgical device consisted of a Robotic Slave Micromanipulator Unit (RSMU) coupled to a Telepresence Surgical System (TeSS). Five mm central full-thickness corneal wounds were fashioned in five enucleated rabbit eyes and repaired remotely using the telerobotic system. Five additional eyes were also repaired by hand using a standard technique. The primary outcome measure was creation of a watertight seal. All eyes in both groups maintained an intraocular pressure (IOP) of 25 mm Hg without leak. The mean repair time was 80 min (range 50-130) with telerobotic surgery compared to 8 min (range 7-9) by hand. Histological evaluation showed that suture placement was similar in robotically assisted repair and manual repair. Subjectively, the telerobotic system provided adequate three-dimensional visualization of the surgical field. The study showed that a surgeon could close standardized corneal wounds using the telerobotic system. The potential benefits of remote eye surgery include improved access, surgical teleconsultation and telementoring.