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S. Patel, J. Solomon; Limitations of Prognostication of Post-Operative Complications With Seidel Testing at Post-Operative Day 1. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5424.
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To determine the relationship between wound instability as identified with seidel testing, post-operative complications and other clinical parameters. Additionally to determine if other modalities of wound testing could provide additional insight.Background: With post-cataract endophthalmitis rates on the rise and the implication of wound instability of clear corneal incisions more attention is being paid to aseptic technique during surgery, but there still lacks information on how to identify patients at risk post-operatively to help further reduce rates.
A prospective study between July and November 2009 of all consecutive patients of three resident surgeons who had cataract extraction by phacoemulsification or extra-capsular technique (ECCE) was performed. All patients underwent extensive wound testing at the end of surgery with documentation of water tight seals. Patients returned for post-operative day one examination at which time wound stability was assessed by seidel testing assessing for spontaneous leakage, as well as leakage induced by forceful blinking and globe compression superior temporally. Other clinical information was also gathered: visual acuity, intraocular pressure (IOP), grading of anterior chamber inflammation, degree of corneal edema, and details of post-operative course.
94 cases were performed, 89 phacoemulsifications and 5 extra-capsular cataract extractions. Wound leaks were identified in 3 (3.3%) phaco cases and 2 (40%) ECCE cases. All 5 wound leaks were spontaneously positive. No additional cases were identified by testing with vigorous blinking or with globe compression. While the average IOP of non-wound leak cases, 23.9, differed significantly from cases with positive leaks, 10.2 (P<0.05), high IOP did not preclude the possibility of wound leakage. Wound leak cases did not differ significantly in terms of visual acuity, anterior chamber grading of inflammation, or presence of corneal edema. One case of endophthalmitis was identified at POD 4, which did not have a wound leak at POD 1, though the clear corneal incision was enlarged from 2.75mm to 4.1mm intraoperatively.
Seidel testing for wound instability has a limited role in prognostication of post-operative complications, namely, endophthalmitis. Additional assessment with blinking and globe compression did not yield any additional helpful information. A new modality of post-operative testing is needed to assess wound stability to better stratify risk of post-operative complications for improved preventative treatment.
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