Comment on: Comparative analysis of non-absorbable 10-0 nylon sutures with absorbable 10-0 vicryl sutures in pediatric cataract surgery.

Sir,

We read the article “Comparative analysis of non-absorbable 10-0 nylon sutures with absorbable 10-0 Vicryl sutures in pediatric cataract surgery” with interest.[1] Sutures are routinely used in pediatric patients below 2 years of age irrespective of wound architecture and leak at the completion of surgery. There are increased risks of suture-related complications, and early removal of nonabsorbable sutures is advocated.[2] In the current study, 34.4% of eyes in nylon group and 19.7% eyes of vicryl group required earlier and unscheduled suture removal. Bringing the children back for suture removal is inconvenient both for the patient and surgeon because of repeat anesthesia risk, time consumption, cost, and increased risk of infection.[3]

We routinely use 10-0 vicryl suture in pediatric cataract surgery since 2016 at our institute, which we do not remove at all. Prior to that, we were using 10-0 nylon suture which were removed routinely at 3 months postoperatively or earlier when required. Endophthalmitis following suture removal are also mentioned in the literature.[4]

On retrospective analysis of our medical records from April 2016 to December 2017, 213 pediatric cataract surgeries (154 with IOL and 59 without IOL) were performed at our institute in children below 2 years of age. In all cases, we applied vicryl [Figs. 1 and 2] and none required either resuturing or suture removal. In 5 eyes, there were debris deposits and 2 had suspected infiltrations at the suture site which were managed conservatively with saline irrigation and topical 5% Povidone solution followed by frequent antibiotic instillation for a week. Absorption of Vicryl suture starts in 2–3 weeks and gets completely absorbed in 60–90 days, and it loses tensile strength up to 75% at 14 days; thus, it appears unnecessary to remove the suture because of its loose and vascularized nature.[5] It is also soft and does not cause any irritations to the child even when knots are exposed or sutures are broken.

Figure 1

Vicryl suture in aphakic child

Figure 2

Vicryl suture in pseudophakic child

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