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Proper architecture key to preventing infection in clear corneal incisions
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NEW ORLEANS — The proper shape and construction of the incision in clear corneal cataract surgery can assist in preventing infection and postoperative complications, a surgeon here said.
The proper dimension of a wound is important to prevent the egress of fluid and ingress of bacteria, Paul H. Ernest, MD, said at the American Academy of Ophthalmology meeting.
"We have been talking about endophthalmitis as a result of a 'less forgiving' incision for years," Dr. Ernest said. "It is time to consider the key factors that give an incision a greater margin of safety, and incorporate as many of them into surgery as one feels comfortable."
Rectangular wounds tend to be less stable and IOP-dependant, while square incisions provide the best mechanical and refractive stability, he said.
Choosing the right incision is essential for the introduction of fibroblasts into the wound to speed healing and prevent infection, he said. Vascular-based, limbal scleral incisions typically heal in around 7 days, as opposed to avascular corneal incisions, which can take 1 to 2 months to heal, Dr. Ernest explained.
He spoke about his role in a multi-center investigation into laboratory testing of wounds, which began in 1990. He and other investigators have looked at "extreme" testing techniques in cadaver eyes and animal models to ascertain the best wound construction.