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    In search of the sutureless closure

    Sealant prevents fluid egress better; maintains patient comfort, surgical efficiency in this surgeon’s hands

     

    Take home

    Stephen S. Lane, MD, describes his technique for using an ocular sealant, as well as cases where he finds it useful and superior to sutures.

     

    Clear corneal incisions quickly gained favor among cataract surgeons because they are easy to perform, require less time, and have minimal effect on astigmatism. In addition, if performed correctly, they are generally self-sealing.

    In case you missed it: Why intensive diagnostic evaluation, management of peripheral ulcerative keratitis is a must

    In spite of these benefits, wound leakage is more common than ophthalmologist may presume, with some reports showing incidence as high as 85%.1-4 The inflow of ocular surface fluid through a fresh postoperative incision may allow bacteria to be introduced to the anterior chamber, and wound incompetence on the first postoperative day has been found to be a significant risk factor for endophthalmitis.5

    Wound integrity

    Sutures have been considered the gold standard for incision closure, but 92% of surgeons responding to a survey by the American Society of Cataract and Refractive Surgery prefer a sutureless closure.6 This is likely due to the disadvantages of sutures which include: inflicting trauma on the cornea, time for suture placement in the operating room, induction of corneal astigmatism, extra office time for removal, and a creating a possible nidus for infection, inflammation, and neovascularization. In addition, the published wound leak with sutures is still almost 24%.4

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