Session: Poster session C

Management of suture granuloma after strabismus surgery

Introduction:



Suture granuloma is a common complication of strabismus surgery, with an estimated occurrence of up to 2.1%. Despite this, there is no standardised protocol for prevention or management. We describe a case report of a 9-year-old female who developed large suture granulomas after undergoing strabismus surgery using 6/0 VICRYL (a synthetic braided absorbable suture made from polyglactin 910). 



Methods:



Case report with literature review.



Results:



The patient underwent uncomplicated right eyed lateral rectus recession and medial rectus resection but developed suture granulomas over the new insertion sites of both muscles within 3 weeks, despite sterile intraoperative techniques and good post-operative drop compliance. The patient was afebrile, had minimal pain and did not respond to initial treatment with hourly dexamethasone 0.1% drops and oral ibuprofen for two weeks. The patient was taken back to theatre for revision surgery. She was found to have extensive granulation tissue overlying the retained suture fragments. The granulation tissue was completely excised, and the conjunctiva sutured with 8/0 VICRYL. There was subsequently good healing with no recurrence at 2 month follow up. The sutures grew Gram negative bacilli (Psychrobacter) on culture.  



Conclusions:

 

Suture granuloma is caused by a foreign body reaction, which may be to suture antigen or bacteria. The main differential diagnosis is infection, which requires very different management. While non-surgical treatments such as topical or oral steroids and beta blockers are known to be helpful, treatment courses are often prolonged over many months, and may still require subsequent surgery. We suggest that early recognition and surgical intervention for suture granuloma can produce safe and effective results without the need for prolonged medical therapy. The suture material used is also likely to be important in determining treatment response, with possible cost implications for theatre procurement.