Eyeworld

EW CATARACT 41 October 2015 Reference 1. Wong M. Using the Wong incision to improve the seal of a clear corneal incision. EyeWorld. 2012;17(6):22–23, 25. Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minn. He has no financial interests related to this article. Dr. Masket has financial interests with Ocular Therapeutix. Contact information Gossman: n1149x@gmail.com Masket: avcmasket@aol.com 11 th International Congress of Corneal Cross-Linking December 4-5, 2015 | Hyatt Regency | Boston, MA USA Hosted for the first time in the United States Register today for the CXL Congress to be part of an international forum for the newest advances in corneal cross-linking Featuring global ophthalmic thought leaders speaking exclusively on the following corneal cross-linking topics: Corneal cross-linking products are not approved for sale in the US. IMA-00034A registration@cxl-congress.com | +44.44.533.37.37 | www.cxl-congress.com International Scientific Committee •Aldo Caporossi, MD, FRCS (Italy) •Peter Hersh, MD, (USA) •Cosimo Mazzotta, MD, PhD, (Italy) •Vance Thompson, MD, (USA) •William J. Dupps, MD, PhD, (USA) •John Marshall, MBE, PhD (UK) •Michael Mrochen, PhD, (Switzerland) •Basic research •Clinical outcomes •Technology •Diagnostics •New indications •Refractive CXL Register today at www.cxl-congress.com/EW typically ReSure sealant [Ocular Therapeutix, Bedford, Mass.]. At the first postop exam (same day or day 1), I check IOP with Fluress [fluorescein sodium and benoxinate hydrochloride, Akorn, Lake Forest, Ill.] and inspect the incisions at the slit lamp. For whatever it's worth, with that method, I have never seen a leak in a routine case since starting temporal clear corneal incisions in 1994." And yet a minority of surgeons checks the incisions with a Seidel test, myself included. My method is to seal the paracentesis if necessary and the main incision with the su- praincisional pocket hydration, i.e., the "Wong way" method, pressurize the eye to physiologic pressure as checked with palpation, dry the in- cisions, and press on the globe to try to provoke a leak, which will be re- vealed as filling of the incision's epi- thelial groove with aqueous. Repeat as necessary. Light perception vision is confirmed to rule out central retinal artery compromise. For the rare incision that is reluctant to seal, I agree with Dr. Masket—no patient leaves the table without bone-dry incisions, so a suture is placed if nec- essary. Paradoxically, the paracente- sis is normally the troublesome one, so I now use a "mini-Wong" pocket above the paracentesis, hydrate this as well, and this considerably reduces OR time. I have confidence that a leak will show up with the provocative test of a dry incision on the table, and while Dr. Masket evidently disagrees with this, a ma- jority of respondents likewise check the incisions without fluorescein. One consideration is the possibility that a normal postop exam with a small leak that goes undetected will eventually seal and to detect it will only generate unnecessary concern and inconvenience for a patient. Or should we be diligent, find them, and correct them at the postop exam in case they contribute to increased risk of endophthalmitis? Not many would fault a practitioner for diligently checking with Seidel's test. This specific case in question and Dr. Masket's opinion might give us pause enough to at least consider checking incisions more thoroughly despite an otherwise normal exam. EW

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