⚡ Key Takeaways
- Corneal sutures get buried under epithelium after a few weeks — you need to free them first
- Create a micro-hook from a 30-gauge needle using the back of your forceps
- The hook grabs the suture from under the epithelium, then the sharp edge cuts it
- Keep the front of the forceps in sterile packaging — only expose the handle
- Apply anaesthetic drops before starting
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The Challenge
When you remove a corneal suture a few weeks after it was placed, the epithelium has often grown over it. This makes it difficult to both see and grab the suture with standard instruments. Professor Goldblum in Basel taught a elegant trick to solve this problem.
Step-by-Step Technique
1. Apply Anaesthetic Drops
Always start with topical anaesthetic drops. Give them a moment to take effect before proceeding.
2. Create the Micro-Hook
Take a 30-gauge needle and attach it to a syringe for better grip. Make sure the bevel faces up. Then take the back of your forceps and slide it along the needle tip a few times with moderate pressure — enough to bend the tip but not break it. This creates a tiny hook at the end of the needle, visible under the microscope.
Close-up: the slightly bent needle tip forms a micro-hook that catches the suture from under the epithelium.
3. Free the Suture
Use the hook to grab onto the suture and pull it out from under the epithelium. The hook catches the suture material and lifts it free.
The micro-hook catches the suture and gently pulls it free from under the epithelium.
4. Cut and Remove
Once the suture is freed, slightly turn the needle and use the sharp edge to cut it. Then use forceps to pull the suture out.
Sterility Note
Keep the front part of the forceps in sterile packaging — only expose the handle for creating the hook. This way, when you use the forceps to grab the suture, the tips remain sterile.
Frequently Asked Questions
When should corneal sutures be removed?
Timing depends on the surgery type and suture material. Nylon sutures after penetrating keratoplasty may stay for months to years. After cataract surgery with a sutured wound, removal typically occurs at 4-8 weeks. Your surgeon will decide based on wound healing and astigmatism.
Can you use scissors instead of the needle technique?
If the suture is superficial and easily visible, standard Vannas scissors work fine. The needle hook technique shines when the suture is buried under epithelium and hard to access with scissors.
Does suture removal hurt?
With proper topical anaesthesia, the procedure is painless. Patients may feel slight pressure but no pain. The procedure takes only a minute or two.
Want to learn how to place corneal sutures?
Check out the 10-step corneal suture guide or subscribe to the YouTube channel for more clinical skills.