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I. W. Porter, G. W. Lyles, K. L. Cohen; Visante Analysis of Sutured Clear Corneal Incisions by a Resident. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6098.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the postop characteristics of sutured clear corneal incisions (CCI) after phacoemulsification performed by a PGY-4 resident using Visante anterior segment OCT (AS-OCT).
11 patients were enrolled prior to cataract surgery. Phacoemulsification was performed by a PGY-4 resident. A 2.75mm keratome was used to create a 1 plane, temporal CCI. Using a 0.9 mm, 30 degree phaco tip, coaxial phacomulsification and insertion of a pcIOL was completed without complication. All CCIs were closed with 1 interrupted 10-0 nylon suture. Patients were examined postoperatively at 1 day, 1 week, and 1 month. The suture was removed at the 1 week visit. AS-OCT images of the CCI were obtained at each visit. The AS-OCT images were analyzed to determine the CCI chord length, incision angle, and wound characteristics.
All CCIs were closed on day 1, and intraocular pressure was 18 mmHg (range 8-31 mmHg). The average chord length was 1.46 mm (range 1.14-1.79 mm), and the average incision angle was 39.9 degrees (range 32.7-51.9 degrees). No CCI had loss of coaptation, epithelial misalignment, epithelial gape, or endothelial gape. Endothelial misalignment was the most prevalent and present in 73%, 55%, and 9% of the patients at 1 day, 1 week, and 1 month. Descemet's membrane detachment was present in 36%, 27%, and 9% at 1 day, 1 week, and 1 month.
CCIs are widely used for phacoemulsification. Often, these wounds are not sutured, which may increase the risk of postoperative endophthalmitis. Using AS-OCT, the sutured CCIs, by a PGY-4 surgeon, are consistently closed. Endothelial misalignment was present in nearly every case, possibly due to the suture pulling the anterior wound temporally. After suture removal, this misalignment resolved over the 1st postoperative month in all but 1 patient. All CCIs showed a smoother profile as they healed with areas of increased reflectivity. A previous study showed 65% endothelial misalignment of unsutured, 3 plane CCIs at 1 hour after phacoemulsification. Sutures appear to be effective in closing CCIs. Endothelial misalignment and Descemet's membrane detachments resolved in all but 1 patient.
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