Corneal Suture Abscess Lead to Wound Dehiscence and Endophthalmitis after Vigorous Eye Rubbing: A Case Report

Introduction Corneal sutures are commonly used in ophthalmic procedures and intraocular surgery including cataract surgery. When the suture become loose and erode through the surface, it might lead to infection. Bacteria can grow both as floating cells in a liquid environment (planktonic growth) and as adherent microcolonies that can evolve to form large biofilms at solid–liquid interfaces (sessile growth) [1]. Biofilm formation requires the adhesion of bacteria to a solid structure, followed by the bacterial production of polysaccharide glycocalyx (slime) that prevents antibiotics from gaining access to the microorganisms and reduces the efficacy of host defenses [1-3]. Biomedical devices (e.g. sutures) are among the solid surfaces that can be colonized by bacteria, with consequences that have been long underestimated, but can often be serious [4]. Complications related to 10-0 nylon sutures, such as abscess, erosions, conjunctival inflammation, tarsal conjunctival ulceration, lid edema, and graft rejection, have been described very well in the context of corneal trans-plantation [5-8]. However, remarkably little is published on infective keratitis secondary to corneal sutures after cataract surgery [5,6,9]. The purpose of this paper is to report a case with unique mechanism of a delayed onset suture related endophthalmitis following cataract surgery due to probable wound dehiscence after vigorous eye rubbing that gave a direct track to the pathogen to access the eye.