Management of traumatic corneal wounds that do not seal after primary closure: a systematic review

Purpose: Open globe injury (OGI) may be associated with corneal wounds that are challenging to close, with a reported wound leakage rate of up to 16%. Management options include conservative and surgical options. No consensus exists on optimal management and studies addressing this have not previously been reviewed. Methods: We conducted a systematic review to identify all studies including adult patients after OGI involving the cornea and requiring secondary closure after primary repair. All studies reporting secondary closure methods and outcomes were reported. Data were combined in a narrative synthesis and methodological quality assessed using Joanna-Briggs critical appraisal tools. Results: Fifty-eight eyes from seven retrospective studies and one prospective study were included. Secondary closure included conservative options of stromal hydration, bandage contact lens, cyanoacrylate glue and aqueous suppressants and surgical management including resuturing, lamellar and full-thickness corneal grafting and scleral autograft with amniotic membrane. One study reported successful conservative management in 26 out of 34 cases (76%) attempted. Re-suturing was successful in 17 out of 20 cases (85%) but required subsequent corneal grafting in three cases. Ten corneal grafts and three scleral autografts with amniotic membrane were successful. Conclusions: Conservative approaches may have a high initial success rate, although these findings were based on a single retrospective study. When conservative approaches were unsuitable or unsuccessful, resuturing leaking wounds was successful in most cases, while lamellar and full-thickness corneal grafting and scleral autograft were additional options.