Suture Complications after Cataract Surgery

Depending on the size and architecture of our incisions for cataract surgery, sutures may be required to ensure adequate closure and good long-term healing. But remember that these sutures are not perfect and they can be associated with complications. They are foreign bodies that must be dealt with carefully in order to avoid complications.

In the picture above, this patient had uneventful cataract surgery with one of our resident surgeons. At the end of the surgery a single 10-0 nylon suture was placed to close the corneal incision because it would not seal with simple hydration. The main issue was the construction of the incision which was not ideal and thus it did not seal well.

OCT scan of the incision shows that it is not sealed.

On post-op day 1 the incision was found to be leaking with fluorescein dye testing. The anterior chamber was very shallow and the intra-ocular pressure was 2 mmHg, which is quite low. This patient required another stitch to properly close the incision. There are guidelines for suture placement which are important to understand.

In another case, shown in the pic below, the patient had cataract surgery years ago with placement of a 10-0 nylon suture. Unfortunately, this suture was improperly placed and was full-thickness, where it penetrated the full corneal depth and entered the anterior chamber. The patient did fine for a few years, but when the exposed suture half wore down and broke, half of the suture was still in the corneal stroma and it created a fistula tract from the anterior chamber to the ocular surface. This resulted in infection, then a hyopyon, and endophthalmitis which was limited to the anterior segment since the capsular bag was still intact. The patient did well with a washout of the anterior chamber, removal of the old suture, closing of the fistula, and re-suturing of the incision, conjunctival coverage of the limbus, and intra-ocular antibiotics.

If you need to use a suture to seal a corneal incision, then certainly, do so. Just make sure that you understand how to properly place, monitor, and possibly remove them.

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