EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 EW NEWS & OPINION 23 influx of fluid that might contain bacteria or other toxic substances. More effective location of stromal hydration The stromal hydration of the sides and superior roof of the clear corneal incision can create the im- pression that the wound is water- tight while the patient is on the operating table. This fluid, however, is often resorbed during the first few hours after surgery because it is rela- tively close to the endothelial pump. Further, my experience with LASIK surgery has shown that apposing stromal lamellae are more adherent when desiccated. Stromal hydration within the channel of the clear corneal incision works in opposition to this concept. On the other hand, stromal hydration in a separate and distinct stromal pocket that is external and anterior to the clear corneal incision typically lasts for 24-36 hours. The inward pressure remains beyond the time period of ciliary shutdown and hypotony. Further, because this supraincisional pocket of fluid is dis- tal to the clear corneal incision with regard to the endothelium, the stro- mal lamellae within the channel of the clear corneal incision are desic- cated and secure before the endothe- lium resorbs the supraincisional fluid. Alternatives Concern over a possible association between clear corneal incisions and the risk of endophthalmitis1 has prompted some surgeons to switch back to scleral tunnels. Relying on a thin layer of conjunctiva that often retracts with blinking, however, is an unreliable defense. Other sur- geons suggest sealing the clear corneal incision with a fibrin adhe- sive, but doing so adds time, ex- pense, and potential toxicity,8 and it may interfere with the desiccation of the stromal lamellae within the channel. Uses I prefer to hydrate a supraincisional pocket with every clear corneal inci- sion for cataract surgery. Other sur- geons use the technique only when the seal of the wound is tenuous at the end of a case. I also find that the technique is useful for a paracentesis of questionable competence, when the corneal structure is less rigid than usual (e.g., when the clear corneal incision is within a limbal relaxing incision or with a young patient), and in situations when an- terior chamber stability is of the ut- most importance during the early post-op period (e.g., after the inser- tion of a Crystalens [Bausch + Lomb, Rochester, N.Y.]) Conclusion The Wong incision aids in sealing a clear corneal incision quickly, easily, and intuitively, and it entails no ad- ditional expense. Practically speak- ing, other than minor epithelial disruptions, this technique is com- plication-free. The best thing I can say about the Wong incision is that the worst thing that can happen is nothing. EW References 1. Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract sur- gery. Arch Ophthalmol. 2005;123:613-620. 2. Mamalis N, Edelhauser H, Dawson D, et al. Toxic anterior segment syndrome. J Cataract Refract Surg. 2006;32:324-333. 3. Ernest P, Kiessling LA, Lavery KT. Relative strength of cataract incisions in cadaver eyes. J Cataract Refract Surg. 1991;17:668-671. continued on page 25 Take Your Practice to the Next Level BY ADDING A HEARING CARE CLINIC Vision and Hearing - Dual Sensory Treatment • Sustainable Business with High Profit Potential Created for Eyecare Professionals by Hearing Professionals Experts in Hearing Care with 240 Locations Nationwide For More Information Call Today! Avada Hearing Care 1-888-982-8232 Partnering Vision & Hearing www.avada.com © 2012 Hearing Healthcare Management, Inc.