Survey of Ophthalmology
Volume 49, Issue 2, Supplement 2 , Pages S62-S72, March 2004

Dynamic morphology of sutureless cataract wounds—effect of incision angle and location☆

Departments of 1Ophthalmology, 2Electrical and Computer Engineering, 3Biomedical Engineering, and 4Beckman Laser Institute, University of California—Irvine, Irvine, California; and 5Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, Maryland, USA

Abstract 

Objective

Sutureless cataract surgery has been growing in popularity over the last decade. These clear corneal incisions allow for rapid visual recovery after phacoemulsification, but may be associated with an increased risk of endophthalmitis. The purpose of this study was to evaluate the effect of intraocular pressure (IOP), location, and angle of cataract incisions on wound apposition and sealing in postmortem globes.

Methods

This was an ex vivo laboratory investigation of 20 rabbit eyes and 14 human eyes. Self-sealing clear corneal, limbal, and scleral incisions were created and IOP was controlled with an infusion cannula. Incisions were made at a variety of angles. Optical coherence tomography was used to image the incisions in real time as the IOP was varied by raising and lowering the infusion bottle, so as to simulate the variation in IOP occurring with blinking or squeezing of the eye.

Results

With each type of incision, optical coherence tomography demonstrated the dynamic nature of cataract wound morphology as IOP was varied. Higher IOPs, in general, were associated with more tightly sealed wounds than lower IOPs, but this varied according to the location and angle of the incisions. More perpendicular incisions, relative to the surface tangent, sealed less well than incisions created at smaller angles at higher levels of IOP; At lower IOPs, the reverse relationship was observed such that more perpendicular incisions sealed less well than smaller incision angles.

Conclusion

Changes in IOP may result in variable and sometime poor wound apposition in sutureless cataract incisions. The type of incision and angle of the incision may affect the likelihood of inoculation of the aqueous humor with potentially pathogenic bacteria. For each type of incision, there may be a critical angle at which the incision is better able to withstand fluctuations in IOP.

Keywords: cataract surgery, clear corneal cataract incisions, endophthalmitis, limbal incisions, optical coherence tomography, scleral incisions, wound structure

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☆ The authors thank Melissa L. Earl, MPH, for assistance with preparation of the manuscript. This manuscript was supported in part by NIH grants EY-10335, EB-00293, NCI-91717, RR-01192, and CA-91717, National Science Foundation grant BES-86924, by an award from the Alcon Research Institute, and by an unrestricted gift from Research to Prevent Blindness, Inc. Beckman Laser Institute Endowment is also gratefully acknowledged. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

PII: S0039-6257(04)00004-9

doi:10.1016/j.survophthal.2004.01.003

Survey of Ophthalmology
Volume 49, Issue 2, Supplement 2 , Pages S62-S72, March 2004

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