Multicenter Evaluation of Propensity for Wound Leaks in Immediate Postoperative Period

Levenson, Jeffrey

Multicenter Evaluation of Propensity for Wound Leaks in Immediate Postoperative Period

Monday, April 28, 2014: 8:37 AM

Room 152 (Boston Convention and Exhibition Center)

Jeffrey H. Levenson, MD, Levenson Eye Associates, Jacksonville, FL, USA

Robert J. Noecker, MD, MBA, Ophthalmic Consultants of Connecticut, Fairfield, CT, USA

Jay S. Pepose, MD, PhD, Pepose Vision Institute, Chesterfield, MO, USA

Steven J. Dell, MD, Texan Eye, Austin, TX, USA

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

Richard Tipperman, MD, Wills Eye Institute, Devon, PA, USA

Narrative Responses:

Purpose
To examine spontaneous and provoked wound leaks following clear corneal cataract surgery.

Methods
500 patients were evaluated in a prospective study at 24 sites throughout the United States. Single plane incisions were evaluated, defined as extending into the corneal stroma and angled down toward the anterior capsule of the lens. A Seidel test was performed at the conclusion of surgery, and spontaneous wound leaks were recorded. A Calibrated Force Gauge (CFG), a device developed to mimic patient-manipulated changes in intraocular pressure, was applied to incisions without spontaneous leaks on the sclera approximately 0.5 mm away from the limbus. Wound leaks were recorded at 0.25 oz. force increments, up to 1.0 oz. force.

Results
488 out of 500 patients exhibited wound leakage. Approximately 50% of wound leaks were spontaneous, and an additional 26% of incisions leaked with minimal force of ≤0.25 oz. Incision sizes ranged from 1.8mm to 3.5 mm, and incision size did not appear to influence wound leak rates. No adverse events occurred in relation to the CFG wound challenge.

Conclusion
Wound leaks were prevalent, whether spontaneous or under point-pressure manipulation. Fluid egress following cataract surgery has been linked to various post-operative complications. Assessment for wound leaks should be undertaken in a standardized and quantifiable fashion and alternative means of wound closure, such as an ocular sealant, should be considered.