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Michelle Overturf, Solomon Ross, Bethany Markowitz; Comparison of Biplanar Cataract Incision Postoperative Architecture With and Without Wound Suture as Performed by a Resident Surgeon. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1849.
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The biplanar clear corneal incision (CCI), is designed to be self-sealing after providing intraocular access for cataract surgery. Inserting large-diameter instruments can induce wound architecture changes that can disturb this self-seal. A surgeon may choose to place a suture at the wound site at the end of surgery to ensure the wound remains water tight. In this study, CCI wound architectural changes were measured via OCT both with and without placement of a suture at the wound site.
Cataract surgery was performed on 18 eyes via biplanar CCI (made with a 2.4mm keratome), by the same resident surgeon. A 10-0 nylon suture was placed through the wound at the end of surgery in 7 of the cases; the remaining had no suture placed. There were no visible intraoperative wound changes at the end of surgery, and all eyes were Seidel negative on postop day 1. An anterior segment OCT 5-Line Raster scan was performed on postop day 1, using the Zeiss Cirrus HD-OCT, and the wound architecture was examined for abnormalities: wound gape, endothelial detachment, and endothelial misalignment. Eyes that had a wound suture placed were then compared to those without a suture.
7 eyes had a wound suture placed; of these, OCT analysis showed 2 (29%) had endothelial misalignment, 2 (29%) had wound gape, and 2(29%) had endothelial detachment, for a total of 6 sutured eyes (89%) having wound changes. 11 eyes had no suture placed; of these, 1 (9%) had endothelial misalignment, 3 (27%) had wound gape, and 3 (27%) had endothelial detachment, for a total of 5 unsutured eyes (64%) with wound changes.
The biplanar CCI is designed to be self-sealing. A suture may be placed at the CCI to ensure the eye remains water tight at the end of surgery. Due to inexperience, resident surgeons are more likely to induce wound instability, and thus to use a suture for securing the wound. In cases where a suture was used, there was an increase in postop day 1 CCI wound changes as detected by OCT. These wound changes may be due to damage caused to the wound during surgery, or could be due to the placement of the suture itself. To prevent wound changes, care must be taken with instrumentation during surgery. Prudence must also be used when determining if a suture should be placed, to prevent potential worsening of the wound changes, and thus worsening wound instability.
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