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Stromal pocket hydration aids in sealing phaco incision, surgeon says
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THOROFARE, N.J. — Creating a superficial pocket above the usual clear corneal incision and then hydrating that pocket can help "self-seal" the incision with greater precision, according to Michael Y. Wong, MD.
Wound leaks, especially those that might allow ingress of bacteria or lipid material, can lead to endophtalmitis or acute inflammation, which is why some surgeons still prefer sclerocorneal incisions when performing phacoemulsification, Dr. Wong added. The stromal hydration technique may help avoid those complications, he said.
The technique is described in the upcoming Mar. 1 issue of Ocular Surgery News.
"A wound is sealed when IOP forces the internal lip of the wound upward, when the wound is narrow enough or long enough to provide sufficient resistance to fluid flow or when it is squeezed tightly by swelling caused by stromal hydration or externally closed by a suture," Dr. Wong said.
Stromal hydration of the wound itself can distort the wound architecture, upset point-to-point apposition and decrease stromal adherence across the wound. The pocket technique avoids the problem of wound distortion.
"With a more secure corneal wound, the margin of safety is increased. There is less pressure on the surgeon to make the wound narrow and long," Dr. Wong said.
Narrow wounds increase the risk of a corneal burn from the phaco handpiece, he said. "Wounds 3 mm wide and 1.5 mm long are adequate." He said these dimensions will leave less corneal edema postoperatively, and the globe can be left relatively soft at the end of the case, giving a greater margin of safety for pressure elevations related to retained viscoelastic material.