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E W CATARACT 7 1 Success with the liquid adhesive bandage I t's a fact of life for cataract surgeons—no matter how well you construct clear corneal incisions, there's a certain number of these that leak, according to Harvey S. Uy, MD, Pa- cific Eye and Laser Institute, Makati City, University of the Philippines, M anila, and St. Luke's Medical Center, Quezon City, Philippines. While some may resort to putting a suture in, new study results pub- lished in the Journal of Cataract & Refractive Surgery indicate that use of a liquid adhesive ocular bandage (OcuSeal, Beaver-Visitec Interna- tional, Waltham, Mass.) may be preferable. Investigators found that the liquid adhesive bandage im- proved wound edge closure, reduced surgically induced astigmatism, and diminished foreign body sensation. Instead of a suture, some practi- tioners try to hydrate the wound to ensure that this is sealed. "This can take several minutes to achieve and sometimes you wind up not sealing the wound anyway, and you still have to put in a stitch," he said. "For a busy surgeon, that takes up time and slows down the rest of the day." Comparing techniques With this in mind, Dr. Uy and fellow investigator Ken Kenyon, MD, thought of using the liquid bandage as a rapid way of sealing a leaky wound. "We thought that by using an adhesive we wouldn't induce any astigmatism, and by covering the wound we'd end up with more patient comfort because the raw edge of the wound would be covered," Dr. Uy said. The investigators embarked on a randomized clinical trial involving 90 consecutive eyes undergoing standard phacoemulsification through a clear corneal wound. "At the end of the surgery, we random- ized patients to receive one of the three treatments—suture, standard stromal hydration, or OcuSeal," Dr. Uy said. Results substantiated early thinking on this. "We thought that if we used a suture, patients would feel a foreign body sensation and be more uncomfortable because there's a foreign body there," he said. "We also thought that if we sutured the wound to stop the leak, we would i nduce some astigmatism." Indeed, results showed that for those receiving sutures there was a significant increase in surgically in- duced astigmatism. "We did serial keratometry after the surgery and we found that the highest astigmatism was induced by using the suture," Dr. Uy said. "But there was no s ignificant difference in astigmatism when we used OcuSeal versus the standard stromal hydration." With these two measures, no astigmatism was induced. As for comfort, investigators re- ported that this was increased with the liquid bandage. "In comparison to the standard stromal hydration, we found that if we apply the OcuSeal there is less sensation of foreign body because the raw edge of the wound is covered," Dr. Uy reported. OcuSeal in practice The only issue some may have with the OcuSeal is that there can be a bit of a learning curve to using this, Dr. Uy thinks. The process involves mix- ing a powder and a liquid solvent, bringing a timing element into play. "If you apply the OcuSeal too soon, it's very liquidy and you might put too much in the field and have a sticky mess," Dr. Uy explained. "If you wait too long the OcuSeal solidi- fies in the applicator and you're not able to brush it on." It then becomes necessary to open a new container and begin again. Dr. Uy finds 15 seconds after mixing the OcuSeal to be the best time to apply this. At that point, the glue is a bit more viscous, allowing for better control, but hasn't stood around long enough to solidify. However, in cases where the OcuSeal is applied too early, all is not lost. "You have to wait and it will solidify in the end," Dr. Uy said. "Then you can trim the excess OcuSeal from the eye." Cost can also be a bit of an issue, he said. This is something for which either the patient or the doc- tor would have to be responsible. "In our practice we generally absorb the cost. If you need it in one of every 50 cases, if you distribute the cost among the 50 patients it's next to nothing," Dr. Uy said. "It's better to have all 50 patients happy than to have 49 happy and one patient complaining of foreign body sensa- t ion in the office to everyone." Dr. Uy recommends that practi- tioners have a few units of this on hand in the operating room. For those just beginning with OcuSeal, he also suggested obtaining some samples from the company to practice the timing needed before performing an actual case. It is i mportant, he finds, to let patients know when the OcuSeal is applied. "You can advise patients after the surgery if you use it," he said. "They may find that there's a sticky feeling by Maxine Lipner EyeWorld Senior Contributing Writer Sticking with clear corneal incisions An open clear corneal wound can be rapidly sealed with a liquid bandage. Use of a liquid adhesive overlying the wound can reduce surgically induced astigmatism, improve wound closure, and diminish foreign body sensation. Source (all): Harvey S. Uy, MD continued on page 72 March 2014 Or watch this video on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Search video number 230 on Clinical.EWrePlay.org EyeWorld Clinical Replay 64-75 Cataract_EW March 2014-DL2_Layout 1 3/6/14 3:10 PM Page 71