After the fourth cardinal suture is placed, the anterior chamber is reformed with saline and wound alignment checked. Cardinal sutures should be replaced if tissue is distributed unevenly or if obvious graft-host interface misalignment (significant over- or under-riding) is evident.
Numerous suturing techniques are used for wound closure, including all-interrupted sutures, combination interrupted/running, and double running sutures. Each has proponents and potential advantages and disadvantages. No single technique has proven superior. Sixteen interrupted sutures complete the wound closure in this case, where stromal vascularization increases the likelihood of uneven would healing and graft rejection.
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