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Sutured Clear Corneal Incision: Wound Apposition and Permeability to Bacterial-Sized Particles

May, William N. MD; Castro-Combs, Juan MD; Kashiwabuchi, Renata T. MD; Tattiyakul, Woranart MD; Qureshi-Said, Saima MD; Hirai, Flavio MD, PhD; Behrens, Ashley MD

doi: 10.1097/ICO.0b013e31824d0d45
Basic Investigation

Purpose: To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink.

Methods: Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter.

Results: The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02).

Conclusions: Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

*Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA

The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.

Reprints: William N. May, 15141 Whittier Boulevard, Suite 480 Whittier, CA 90603 (e-mail:

Supported by the May Vision Foundation, Los Angeles, California; an unrestricted grant from Research to Prevent Blindness, New York, New York, to Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; and a Research to Prevent Blindness Althouse Special Scholars Award and Fight For Sight, New York, New York.

The authors state that they have no proprietary interest in the products named in this article.

Received November 21, 2011

Accepted January 23, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.