|Year : 1983 | Volume
| Issue : 6 | Page : 805-806
Electro-coaptation of conjunctival wounds
Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi, India
S K Angra
Dr. Rajendra Prasand Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-110029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Angra S K. Electro-coaptation of conjunctival wounds. Indian J Ophthalmol 1983;31:805-6
The electro-coaptive closure of conjunetivall wound is like a "tissue spot welding", by passing a high frequency current through a bipolar forceps to initiate a plastic adherent coagulum between the approximated edges of conjunctival wounds.
An attempt has been made to evaluate this procedure in an effort to avoid removal of conjunctival sutures which are hazardous and require general anaesthesia in infants.
| Material and methods|| |
40 congenital cataract simultaneous irrgation-aspiration cases had conjunctival wound closed by:
l. Electro-coaptation of conjunctiva - 30 cases.
2. Vicryle suture 7 zero (continuous) - 10 cases
3. Vigin silk 7 zero (continuous) - 10 cases
The corneoscleral wound has been closed by single hurried vicryl suture.
Technique of Electro-coaptation:
(1) Conjunctival tissue is approximated with slight pressure by bipolar forceps with smooth polish surface to avoid tissue to metal adhesions [Figure - 1]. Counter fixation near the tip of coaptive bipolar forceps may be done if conjunctiva is under tension.
(2) Current activation for electrocoaptation is done in short burst for 10-20 sec. only. We have used Codman Mentor coagulator. Other equipments which can also be used are as under:
Equipment Setting No.
Burton Cavitron 3-5
Codman Mentor 20
Mira Diathermy (0.75 sec.) 2-3
For wet field procedure, one step higher current is required. [Figure - 2]
(3) Observe slight tissue shrinkage and pucker.
(4) The coaptive forceps should be slide along the track of the application, rather that opened apart. The latter will pull apart the Coagulum.
| Observations|| |
The thirty cases of cojunctival coaptation done (approx. 150 spots in total) showed failure of coaptation i.e. breaking up of coaptation, in 4 spots. In post-operative period 2 spots gaped only.
The reaction in the conjunctival section was of the similar nature as that of silk continuous suture. The local slight conjunctival hyperaemic reaction of the vicryl suture persisted till the suture is absorbed i.e. upto 40-50 days.
| Discussion|| |
The procedure can be done for limbal based or fornix based flaps equally effective. This
can be done in dry or wet fields depending on the choice of the surgeon.
In the technique, the avoidance of Tenons capsule between the blades of coaptive bipolar forceps is essential otherwise the coagulum formed has no adhesive effect or graping occurs
in the post operative period.
This method makes the pateints more comfortable and avoids any removal of sutures. When compared with Vicryal suture this procedure is superior as the healing does not involve chemical degradation of the suture material which produces a hyperaemic local response.
The final healing is same as has been with conventional silk sutures but has reduced the operative time besides the avoidance of general anaesthesia in our cases for the removal of silk suture.
| Summary|| |
Electrocoaptation procedure to coapt conjunctival wounds has been evaluated.
| References|| |
Nidler M.P.,Lehman R.N. and Pavlis R.J., 1976;' Current concepts in cataract surgery, ed. Emery J.M. & Paton D., p.79. C. V. Mosby St. Louis.
[Figure - 1], [Figure - 2]