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Clear corneal incisions may be responsible for endophthalmitis rise
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FLORENCE, Italy — The clear corneal incision, a staple of cataract surgery technique since the 1990s, may be responsible for a dramatic increase in the incidence of endophthalmitis over the past decade, several speakers said here at the Florence Symposium.
The transient IOP drop that follows phacoemulsification might cause the unsutured wound to open and allow fluid to carry bacteria into the eye, suggested Terrence O’Brien, MD.
Samuel Masket, MD, suggested that the IntraLase FS femtosecond laser may allow surgeons to create a better self-sealing incision.
“The laser beam produces the corneal tunnel from the inside to the surface, and all you need is to deepen it with a blade, till you reach the anterior chamber,” he said. “In this way, incisions don’t leak.”
Alternatively, T. Kim, MD, suggested using a self-gelling glue to seal the incision. He said the adhesive does not dissolve in the watery corneal environment and will, therefore, form a stable protective barrier over the wound.
Dr. O’Brien said a potentially easier solution may be the use of a vicryl suture in selected cases.
“It’s a very cost-effective investment when you suspect the incision might be leaking,” Dr. O’Brien said.
The surgeons presented these opinions in a session at the Florence Symposium, the Joint Meeting of Ocular Surgery News, the Italian Association of Cataract and Refractive Surgery and the Italian Society of Ophthalmology.