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Effect of wound location, orientation, direction, and postoperative time on unsutured corneal wound healing
1Ophthalmology Research Laboratory, Sharp Cabrillo Hospital, San Diego, Calif 92110.
Background:
Clinical observation suggests the location, orientation, direction, and postoperative time of unsutured corneal wounds may affect healing.
Methods:
We studied wound depth, deviation, width, and healing phases in central to peripheral portions of superior and inferior transverse incisions, and centripetal and centrifugal semiradial incisions. Healing phases were quantified by the amount of epithelial plug elimination and by fibroblast orientation to the wound.
Results:
Healing rates varied among individual monkeys. Complete stromal wound closure was seen as early as 2.5 months postoperative, whereas epithelial plugs were present up to 11 months. Average depth did not differ between superior (61.7% +/- 13.4%) and inferior transverse incisions (66.3% +/- 8.2%) (p > .1); all incisions deviated toward the limbus (28.9 degrees +/- 19.9 degrees and 31.0 degrees +/- 19.8 degrees) (p > .1). Superior transverse wounds showed advanced healing compared to mate inferior wounds (p < .05). Compared to centrifugal wounds, centripetal wounds had greater depth (48.1% +/- 7.3% versus 76.0% +/- 7.0%) (p < .0005), greater width (17.2 microns +/- 4.5 microns versus 27.8 microns +/- 6.9 microns) (p < .01), and earlier healing phases (p < .025). With longer postoperative time intervals, fibroblast orientation appeared to change from a relatively perpendicular to a parallel orientation to the wound.
Conclusions:
Transverse incisions may be difficult to perform perpendicular to the corneal surface. Superior transverse wounds may heal faster than mate inferior wounds, and centrifugal radial wounds may heal faster than centripetal wounds. Differences in semiradial wound morphology may be related primarily to incision depth and postoperative time; incision direction may also affect wound healing.