Management of traumatic corneal wounds that do not seal after primary closure: a systematic review
Smith, Ben MacDonald, Trystan McClellan, Scott F Justin, Grant A Agrawal, Rupesh Hoskin, Annette K Cavuoto, Kara Leong, James Rousselot Ascarza, Andrés Woreta, Fasika A
Smith, Ben
MacDonald, Trystan
McClellan, Scott F
Justin, Grant A
Agrawal, Rupesh
Hoskin, Annette K
Cavuoto, Kara
Leong, James
Rousselot Ascarza, Andrés
Woreta, Fasika A
Abstract
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.
MIDER Authors
Affiliations
University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; Birmingham Biomedical Research Centre; Defence Health Agency; Uniformed Services University of the Health Sciences; Duke University Hospitals; Tan Tock Seng Hospital; Singapore Eye Research Institute; Lee Kong Chian School of Medicine; Duke NUS Medical School; University of Sydney; University of Western Australia; University of Miami; Sydney Eye Hospital; Consultorios Oftalmológicos Benisek-Ascarza; Navy Medical Center Portsmouth; White River Junction Veterans Administration Medical Center; Dartmouth-Hitchcock Medical Center; University of Surrey; Guy's and St Thomas' NHS Foundation Trust; Manchester University NHS Foundation Trust; Birmingham Institute for Glaucoma Research; National University Hospital Singapore; Helen Keller Foundation for Research and Education; University of Pécs; Worcestershire Acute Hospitals NHS Trust; Northumbria University; Royal Centre for Defence Medicine
Date
2026-03-13
Type
Article
Collections
Citation
Smith B, MacDonald T, McClellan SF, Justin GA, Agrawal R, Hoskin AK, Cavuoto K, Leong J, Rousselot Ascarza A, Woreta FA, Miller KE, Gensheimer WG, Williamson TH, Dhawahir-Scala F, Shah P, Sundar G, Mazzoli RA, Kuhn F, Woodcock M, Watson SL, Colyer M, Gomes RS, Blanch RJ. Management of traumatic corneal wounds that do not seal after primary closure: a systematic review. Eye (Lond). 2026 Jun;40(8):1113-1120. doi: 10.1038/s41433-026-04352-0. Epub 2026 Mar 13.