BLOG: When a cataract wound sealant makes sense

ByJohn A. Hovanesian, MD, FACS

The cover story in this issue of Ocular Surgery News explores new technologies in cornea and external disease and includes great expert input on how to fit them in clinical practice.

One new product that has changed my practice is the hydrogel wound sealant called ReSure from Ocular Therapeutix. This liquid sealant polymerizes to a gel within seconds after application to a dry cataract wound, allowing wound closure that was proved better than sutures in FDA studies.

A full explanation of how to use this material, including surgical pearls, is available at http://youtu.be/aEi5wDKvZdU.

I always hesitate to use any new product that costs the system more, whether reimbursed or not, unless there is a clear value to the patient’s care. For cataract wounds, I would not suggest that this product is for every eye, but it certainly is for every surgeon. Each of us has cases that uniquely would benefit from extra assurance of wound closure:

Patients colonized with MRSA in whom a better sealed wound might prevent entry of resistant organisms.
Patients with pseudoexfoliation or intraoperative floppy iris syndrome in whom a small pupil may prolapse into an open wound postoperatively.
Weird wounds in which irregularity, previous corneal surgery, wound burns or epithelial defects might compromise natural closure.
Patients with premium implants in whom small postoperative wound leaks might cause a surprise myopic outcome in as many as 50% of patients, as I showed in a study.
Eyes with ruptured posterior capsules in which a leak might allow vitreous prolapse.

You can certainly think of more examples. Every surgery center should probably have ReSure sealant available, and every surgeon should become familiar with application techniques for these common scenarios in which we can raise our level of care by using this promising new technology.

Disclosure: Hovanesian reports he is a consultant for Ocular Therapeutix.