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A prospective randomized study of 500 eyes at 24 sites has found that a hydrogel sealant (ReSure) was significantly better than sutures in stopping leakage following clear corneal incision (CCI) cataract surgery.1 Patients who were found to have wound leaks, either spontaneous or with application of calibrated pressure, after uneventful surgery were randomized to receive either sealant or sutures. At follow-up visits, leakage occurred with pressure provocation in 12 of 295 eyes of the sealant group (4.1 percent) versus 60 of 176 sutured eyes (34.1 percent).
A role for both. But cataract surgeons should not abandon their needles. “Sealant and sutures each play a different role,” said author Samuel Masket, MD, a cataract surgeon in Los Angeles. The type of wound construction will determine the surgical course.
He noted that previous investigations revealed that a paracentesis-type incision without a groove is most likely to leak. That common type of wound construction—single-plane CCI of 3.5 mm or less—was used for all eyes in this study.
The sealant’s value is in covering and hermetically sealing the incision in the postoperative period while the epithelium is healing, Dr. Masket said. “While sealant cannot make up for poor incision construction, in this investigational model it proved to be more effective than sutures.”
A high incidence of leakage. Though the researchers anticipated leakage, they were surprised by the large proportion of incisions—488 of the overall 500, or 97.6 percent—that initially leaked, either spontaneously or with provocation equivalent to forced blinking or eye touching. “This is a sobering piece of information that surgeons should heed,” Dr. Masket said.
Key takeaways. “Incision construction definitely matters, and leaking wounds are a concern,” he said. “Surgeons should take the opportunity to carefully test the incision. And don’t leave the table with a leaking wound.”
—Miriam Karmel
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1 Masket S et al. J Cataract Refract Surg. 2014;40(12):20572066.
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Dr. Masket is a consultant to, shareholder of, and medical monitor for Ocular Therapeutix.
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