Comparison of Intraoperative Wound Leakage in Clear Corneal Incisions After Closure With Stromal Hydration, Suture, or Ocular Sealant

Masket, Samuel

Comparison of Intraoperative Wound Leakage in Clear Corneal Incisions After Closure With Stromal Hydration, Suture, or Ocular Sealant

Saturday, April 26, 2014: 2:02 PM

Room 151A (Boston Convention and Exhibition Center)

Samuel Masket, MD, Advanced Vision Care, Los Angeles, CA, USA

Eric D. Donnenfeld, MD, Ophthalmic Consultants of Long Island, Rockville Centre, NY, USA

John F. Doane, MD, Discover Vision Centers, Leawood, Kansas, USA

Bonnie An Henderson, MD, Tufts University School of Medicine, Waltham, MA, USA

Terry Kim, MD, Duke University Eye Center, Durham, NC, USA

Michael J. Endl, MD, Fichte-Endl Eye Associates, Niagara Falls, New York, USA

Narrative Responses:

Purpose
To evaluate intraoperative wound leakage in clear corneal cataract incisions (CCI) after closing the incision using stromal hydration, suture or an ocular sealant.

Methods
Three prospective multicenter studies were conducted on patients undergoing cataract surgery. All incisions in all studies were tested for wound leak using the same standardized method. Incisions were first tested for spontaneous leaks using a Seidel test. If there was no spontaneous leak, incisions were then tested for provoked leaks using a Seidel test and a Calibrated Force Gauge (CFG) to apply up to 1 ounce force (ozf). Across the three studies, 535 subjects (537 eyes) were enrolled and had their CCIs closed using stromal hydration (n=30), suture (n=204) or an ocular sealant (n=303).

Results
Sixty-seven percent (20/30) of incisions leaked after closure with stromal hydration, 31% (63/204) leaked after suture closure and 4% (11/303) leaked after application of an ocular sealant.

Conclusion
Clear corneal cataract incisions are susceptible to leakage. Even after the use of standard closure methods of sutures and stromal hydration, many incisions leak when subjected to external forces representative of eye touching or rubbing. An ocular sealant appears to be an effective option for prevention of incision leaks.