Evaluation of Sutures for Wound Closure of Clear Corneal Incisions With Wound Leaks

Monday, April 28, 2014: 8:32 AM
Room 152 (Boston Convention and Exhibition Center)
Michael B. Raizman, MD, Ophthalmic Consultants of Boston, Boston, MA, USA
William J. Flynn, MD, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
Stephen S. Lane, MD, Associated Eye Care, Stillwater, MN, USA
Y. Ralph Chu, MD, Chu Vision Institute, Bloomington, MN, USA
Jonathan H. Talamo, MD, Talamo Hatch Laser Eye Consultants, Waltham, MA, USA
Farrell C. Tyson, MD, FACS, Cape Coral Eye Center, Cape Coral, FL, USA

Narrative Responses:

Purpose
To evaluate the effectiveness of sutures for wound closure following clear corneal cataract surgery in healthy patients with a demonstrated wound leak.

Methods
183 patients with demonstrated spontaneous or provoked wound leaks using a Calibrated Force Gauge (CFG)(up to 1 ozf.) were evaluated in a prospective study at 23 sites in the United States.  One or more 10-0 nylon sutures using a 3-1-1 technique with buried knot were used to close the wound.  Stromal hydration was used at the investigators’ discretion.  A Seidel test was performed to detect any fluid egress, and the CFG was used to challenge wounds by simulating intraocular pressure fluctuations.  A Seidel test was performed at days 1, 3, 7, and 28 post-operatively.   Sutures were removed at day 28.

Results
Mean incision length was 2.72 mm ±0.21.  Prior to suture application, 50.3% (n=93) of wounds leaked spontaneously, and the remaining wounds (n=90) leaked under CFG challenge.  76.9% of wounds were stromally hydrated in conjunction with suture placement.  Following suture placement, 2.2% (n=4) of wounds leaked spontaneously, and an additional 29.5% (n=54) of wounds leaked under simulated intraocular pressure fluctuations using the CFG.  30.6% (n=56) of patients experienced at least one suture-related adverse event (AE), and 12.6% (n=23) of sutures had to be prematurely removed due to AEs.

Conclusion
Sutures failed to prevent fluid egress from approximately one-third of clear corneal incisions, and resulted in a number of device-related AEs.  Additional measures or alternative devices, such as ocular sealants, may be needed for definitive wound closure without leak.