Burn and Bury: A Novel Technique to Avoid Conjunctival Peritomy

Introduction: To evaluate the safety and feasibility of a novel surgical technique for subconjunctival burial of 10-0 Prolene sutures without conjunctival peritomy. Methods: Retrospective case series of 12 patients who underwent trans-scleral suture fixation or silicone oil retention suture placement using 10-0 Prolene sutures between January 2024 and February 2025 at Sant'Anna University Hospital, University of Ferrara, Italy. Inclusion criteria: adults requiring scleral fixation with 10-0 Prolene. Exclusion criteria: prior conjunctival surgery at the site, active ocular surface disease, or inability to complete follow-up. Instead of conjunctival peritomy, a linear high-temperature cautery was applied along the intended suture path to create a fibrotic track. Sutures were passed trans-scleral and left exposed on the cauterized zone, allowing spontaneous re-epithelialization. Follow-up included slit-lamp examination, anterior segment photography, and optical coherence tomography (AS-OCT) at 1 day, 1 week, 1, 3 and 6 months. Results: 12 patients (12 eyes) were included. Successful suture burial was achieved in all 12 eyes (100%) without exposure, extrusion, or conjunctival dehiscence during the 6-month follow-up. Re-epithelialization was complete by day 7 in all cases (12/12, 100%). No patient reported foreign body sensation after day 7. There were no infections, granulomas, or surgery revisions. Conclusions: The “Burn and Bury” technique is a safe, and minimally invasive alternative to conjunctival peritomy for burying trans-scleral Prolene sutures. It preserves conjunctival integrity, reduces surgical trauma, promotes rapid epithelial healing, and enhances patient comfort. This technique may be broadly applicable in anterior segment procedures requiring scleral suture fixation and warrants prospective validation.