Transcript Evaluation of wound closure using sutures for prevention of fluid

Jeffrey Levenson, MD, Levenson Eye Associates
Farrell Tyson II, MD, Cape Coral Eye Center
William Flynn, MD, Rashid, Rice & Flynn Eye Associates
The authors have no financial interest in the subject matter of this e-poster.
J Cataract Refract Surg 2005; 31:735–741
“Postoperative contamination is a problem with sutureless incisions…”
“Our greatest association was a leaky wound on the first
postoperative day… with a 44-fold increased risk...”
To evaluate the effectiveness of suture(s) for wound
closure to prevent fluid egress from clear corneal
cataract incisions (CCI).
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
A Calibrated Force Gauge (CFG) was developed to apply consistent
and quantifiable force to the ocular surface.

Up to 1 ounce of force applied 0.5 mm away from the scleral side of
the incision.

Incision monitored for Seidel and recorded for wound leaks in 0.25
ounce force increments.
Depressed Calibrated Force Gauge
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Levenson Eye Associates, Jeffrey Levenson, MD
Midwest Center for Sight, James Katz, MD
Cape Coral Eye Center, Farrell Tyson II, MD
Discover Vision Centers, John Doane, MD
R & R Eye Associates, William Flynn, MD
Texan Eye, Steven Dell, MD
Harvard Eye Associates, John Hovanesian, MD
Jacksoneye, Mitchell Jackson, MD
Associated Eye Care, Stephen Lane, MD
Pepose Vision Institute, Jay Pepose, MD
Ophthalmic Consultants of Long Island, Eric Donnenfeld, MD
Duke Eye Center, Preeya Gupta, MD
Ophthalmic Consultants of Boston, Michael Raizman, MD
Alterman, Modi & Wolter, Satish Modi, MD
Chu Vision Institute, Y. Ralph Chu, MD
Cincinnati Eye Institute, Michael Snyder, MD
Ophthalmic Consultants of Connecticut, Robert Noecker, MD
Comprehensive Eye Care, Michael Korenfeld, MD
Chicago Cornea Consultants, Parag Majmudar, MD
Fichte, Endl & Elmer Eyecare, Michael Endl, MD
Ophthalmic Consultants of Boston, Bonnie Henderson, MD
See Clearly Vision, Rajesh Rajpal, MD
Ophthalmic Partners of Pennsylvania, Richard Tipperman, MD
Talamo Laser Eye Consultants, Jonathan Talamo, MD
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Uneventful clear corneal cataract surgery.
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Single plane incision (no groove).
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Study eye brought to physiological pressure.

Seidel positive incision upon first challenge with CFG prior to suture
placement.
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One or more 10-0 nylon sutures were placed perpendicular to the
incision using a 3-1-1 technique with buried knot.

Stromal hydration administered at the Investigator’s discretion.

The CFG was used a second time to challenge the wound and
examined for Seidel.

Seidel test was repeated at 1, 3, 7 and 28 days post-operatively.
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183 patients enrolled in the study:
Parameter
Mean
Incision Width
2.73 mm ± 0.21
Tunnel Length
2.28 mm ± 0.49
Stromal hydration used?
n (%)
Yes
141 (77%)
No
42 (23%)
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Wound leak rates
100
51%
Prior to suture application (n=183)
90
After suture application (n=183)
# of wound leaks
80
70
60
50
23%
40
30
11.5%
20
10
12%
11.5%
6.0%
7.7%
2.7%
2.2%
4.4%
0
Spontaneous
0 ≤ .25 oz.
.26 ≤ .50 oz.
.51 ≤ .75 oz.
.76 ≤ 1.00 oz.
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
Before Suture:
 51% of wounds leaked spontaneously
 74% of wounds leaked spontaneously or with ≤ 0.25 ounces of force (minimal touch)

After Suture:
 31.7% of sutured wounds leaked with ≤ 1.0 ounce of force

30.6% of subjects experienced at least one suture-related adverse event
including:
 Subconjunctival hemorrhage
 IOP ≥ 30 mmHg or 10 mmHg over baseline
 Induced corneal astigmatism (threshold of 3 diopters)
 Corneal edema
 Pain/discomfort
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
Of the sutured wounds that leaked, 43.1% leaked spontaneously or
with minimal touch pressure (≤ 0.25 ounces of force).

Sutured wound closure, although considered the “gold-standard” for
CCI wound closure, may be subject to wound leaks post-operatively.
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More protection may be necessary to safeguard CCIs in the
immediate post-operative period.
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