Endophthalmitis Following Delayed Gore-Tex Suture Rotation: A Lesson in Suture Management.

Purpose: To highlight occurrence and management of an important surgical complication.

Methods: Retrospective case review.

Results: A 35-year-old Caucasian female with a history of crystalline lens dislocation secondary to Marfan Syndrome was referred for management of chronically exposed Gore-Tex suture knots following AKREOS 4-point fixation six years prior. The initial surgery was reportedly complicated by hypotony leading to multiple attempted wound revisions. Ultimately, the patient remained with chronically exposed suture knots. Upon referral to our practice, the knots of the left eye were rotated into the eye, leading to endophthalmitis refractory to two rounds of intravitreal antibiotics. Infection was controlled only after removal of all preexisting hardware, suggesting colonization of the suture material. In the other eye, the decision was made to remove all preexisting sutures and re-fixate the initial lens using new suture. The patient achieved 20/20 vision in both eyes with implantation of a new secondary IOL in one eye and with removal of all preexisting sutures in the other eye.

Conclusion: This report highlights a case of endophthalmitis following delayed rotation of exposed suture. Based on the outcome of this case, the importance of avoiding suture exposure is highlighted, and options to manage chronically exposed suture are discussed.