Surgeon recommends use of sealants to close corneal incisions

Issue: December 25, 2014

NEW YORK — Cataract surgeons should be confident that a hydrogel sealant used to close corneal incisions will prevent wound leakage with fewer adverse events than sutures and no need for removal, according to a speaker here.

“The inconvenient truth about what we do is that there are corneal incisions that we assume we seal but do not,” John A. Hovanesian, MD, FACS, said at OSN New York 2014.

John A. Hovanesian

Depending on the study, leak rates for these incisions after cataract procedures can reach 85%, he said, particularly when those wounds are challenged by external forces that might happen under ordinary circumstances, such as eye rubbing and touching or coughing and sneezing.

Even perfectly constructed wounds can be compromised because IOP can fluctuate, he said. “Leaks can lead to complications: hypotony, corneal decompensation and epithelial downgrowth,” Hovanesian said.

Hovanesian said he uses ReSure sealant (Ocular Therapeutix), a soft, synthetic hydrogel that seals clear corneal incisions, diffuses in 1 hour and sloughs in the tears during re-epithelialization.

In a pivotal clinical trial comparing the sealant and sutures, Hovanesian and colleagues used Seidel testing to find a 4% leak rate in the 304 patients in the sealant group and a 34% leak rate in the 183 patients in the sutures group.

Furthermore, sealant was considered easy to use in 94% of cases, and there were no significant differences in surgically induced corneal astigmatism, anterior chamber inflammation, manifest refraction, corneal astigmatism, corneal edema, asymmetry, pain or best corrected visual acuity, he said.

“This certainly is a technology that is for every surgeon and every operating room because there are going to be cases where you are selectively going to want to seal a wound with something that works better than suture,” Hovanesian said.

Disclosure: Hovanesian has relevant financial interest in Ocular Therapeutix.