EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
EW CATARACT 36 May 2015 by Jai G. Parekh, MD, MBA F or a number of years, clear corneal incisions have been the standard for cataract surgery. This procedure requires less healing time, generally has minimal effect on astigmatism, and in the majority of cases the incisions are self-sealing. However, there are instances in which a suture is needed to ensure the integrity of the wound. Normal hydrostatic forces of the cornea tend to create good wound closure, but wound leakage is far more prevalent than many think, with some reports listing the incidence rate up to 85%. 1,2,3,4 It is imperative to prevent wound leakage from occurring in order to reduce the likelihood of bacteria entering the anterior cham- ber and causing infection. But until recently there has not been an alter- native to suturing these wounds. The risk of losing wound integ- rity is increased when dealing with more complicated cataract cases. My practice treats a large number of old- er patients, many of whom are more complex cases as they have diabetes, kidney disease, and rheumatoid arthritis. Some are on tamsulosin with dense cataracts (requiring more intraoperative instrumentation), or are otherwise at greater risk of devel- oping wound complications. In or- der to ensure proper wound closure, I began to suture all my high-risk patients. This gave me greater peace of mind in regard to maintaining the architecture of the wound, but it also introduced several worrisome issues. For sutures, I tend to use one standard 10-0 nylon suture using a 3-1-1 technique with buried knot format. While sutures are mostly ef- ficient for my patients, they do have Maintaining wound architecture and integrity with sealant Mixing key components in less than 7 seconds Simple and gentle application of the sealant Source: Jai G. Parekh, MD, MBA disadvantages other than wound leakage. In addition to relative time factors and inducing some astig- matism, they need to be removed, which can at times be problematic. Also, sutures can create a possible breeding ground for infection and inflict problems with the cornea, especially if you have a patient with a propensity for eye rubbing. Sutures also still have a published leak per- centage up to 34.1%. 4 New standard for wound closure Before when closing wounds in my more complicated patients I might have put in a stitch, but now I am using the ReSure Sealant (Ocular Therapeutix, Bedford, Mass.). It has become the standard of care for all my complex cataract patients. I use the ReSure Sealant with equal if not greater confidence in knowing that the wound is truly closed. For me, this sealant has been a game chang- er in how we take care of the wound at the hospital level. Not only has it improved overall wound archi- tecture and maintenance of wound integrity, but it has also given me true peace of mind that I have done everything possible to take care of the wound. This is especially true with my dense cataract and tamsulosin patients, as they not only have a greater risk of complications such as floppy iris syndrome but also have more vulnerable wounds. Out of my first 108 patients using the sealant, nearly one-third were taking tamsu- losin. For these patients, I have used iris retractors and other techniques to help give my patients the best care possible. However, these devices require extra manipulation of the wound during insertion and remov- al, which can stretch or augment the