How to improve the outcome of corneal laceration repair

1. Corneal Laceration
Repair
· Mohamed Zaky Elkadim MD
· 2020

2. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

3. Aim
5 advises to improve visual outcome
of repair of corneal laceration

4. 1
Antibiotic Prophylaxis
Inject through the wound or side port
Avoid intravitreal injection except if there is evidence of
endophthalmitis or IOFP as injection in soft tesnsion can
induce lens , retinal or choroidal injury

5. Hypopyon?
· Presence of hypopyon particularly in
neglected wounds and pediatrics not
equal endophthalmitis but may be just
reaction.

6. 2
Amniotic Membrane On-lay
for severely lacerated
wound

10. Leaky wound
Tight sutures
Astigmatism
Glue / AMT
Increase
number of
sutures
Opacity
PKP
RGP

11. Role of AMT
· Close small defects : decrease number
of sutures / pupil sparing sutures
· Prevent over tight suturing
· Stimulate healing.
· Anti-inflammatory
ConvertsLacerated Incision to Blade incision

12. Too aggressive

13. Surgical technique
 Strip of AM is applied to the wound
from the start.
 Wound is sutured with interrupted
nylon 10/0 sutures including the AM
strip.
 Suturing is avoided in the visual axis
 Bandage soft CL is applied.

14. CASE 1

15. Preoperative (persistent leak)

16. Post operative

18. After suture removal

21. Spectacle BCVA
Refraction BCVA K - reading
+1.00 /
-1.5 x 100
0.3 42.25
44.00
Senile
macular
degenration

22. CASE 2

24. Note the long suture is taken to avoid
suturing in the visual axis

25. CASE 3

26. · Middle age
· Clean cut

29. Keratoscopy

30. Spectacle BCVA
BCVA
(with glasses)
K - reading
0.5 44.9 / 47.3
cataract

31. CASE 4

32. preoperative

33. Post operative

34. Note that sutures near the center should be
shorter and will spaced

35. After vitrectomy

36. After Vitrectomy

37. Pentacam

38. Spectacle BCVA
Refraction BCVA
(with soft
CL)
K - reading
+ 10 0.4
44.00
46.00

39. Post operative complications
· Early post operative hypotony
· Early membrane displacement
· Difficult suturing and membrane tears
· ? Poor intraocular visualization

40. 3
Traumatic Cataract with
open anterior capsule

41. Problem with traumatic
cataract
· Posterior capsule usually open.
· Prolapsed Vitreous = incomplete removal
of lens matter.
· Dropped lens = severe vitritis.
· Cyclitic membrane or vitrectomy ==
Atrophia.

42. Prognostic factors
· Surgeon experience
· Age of the patient
* < 10 ys
* 15 – 25 ys
* Hard cataract
· Size of the corneal wound

43. Advantage to do
· Avoid near second anesthesia
· Removal of IOFP

44. Technique
· Close the wound 1st.
· Dilate pupil and
· Identify the capsular
· opening
· 2 side ports perpendicular to capsular
tear.

45. AC should be stable with
Healon
· Gradual prolapse of the lens matter in
the AC using viscodissection.
· Slow motion I/A in the AC with
injection of OVD once AC get shallow

46. AC should be stable with
Healon
· Very deep AC = lens matter will drop
· Very shallow AC = vitreous will
prolapse.

49. 4
Refractive Correction ±
Amblyopia therapy

50. Which is optically better in a
case with corneal scar ??
· Hyperopic glasses
· Soft contact lens
· Ac IOL
· Artisan
· Yamane technique

51. How to get the axis of astigmatism
in cases with corneal opacity ?
· Autoref
· Topography
· Uniocular trial
· Binocular trial

52. Refraction
+ 1.5
Trial sphere
and cylinder

53. Which is optically better in a
case with corneal scar ??
· Hyperopic glasses
· Soft contact lens
· Ac IOL
· Artisan
· Yamane technique

54. If the bag is intact ??
· Single piece IOL in the bag ?
· Three piece IOL in the sulcus ?

55. 5

56. ‫هلل‬ ‫الحمد‬