Inflow of Ocular Surface Fluid Into the Anterior Chamber After Phacoemulsification Through Sutureless Corneal Cataract Wounds

Abstract

Abstract: : Purpose: To report the inflow of ocular surface fluid after cataract surgery using standard sutureless corneal incisions. Methods: Design: Observational case series at Wilmer Eye Institute. Patients: 8 individuals (3 female), aged 58 to 91 years, showing minimal bleeding from the limbal capillary bed during phacoemulsification, were included in the study. Intervention: Surgery was performed through a 2.8 mm limbal incision, which was later expanded to 3.2 mm for intraocular lens insertion. External pressure was applied in the incision vicinity with an irrigation cannula, to simulate digital pressure or blinking. This procedure was performed before and after wound hydrosealing. Main Outcome Measures: Inflow of blood–tinged tear fluid into the anterior chamber through the sutureless wound was monitored using digital video recording. Results: Inflow of blood–tinged precorneal tear fluid was observed when the cannula was released. Hydration of the wound did not prevent fluid inflow, although outflow of aqueous was prevented. Two patients showed spontaneous blood inflow, one of them before cortex aspiration. Hypotony may have been the triggering event for the inflow to occur in these cases. Conclusions: Sutureless corneal incisions allow the inflow of blood and surface fluid into the anterior chamber after surgery. This represents a possible mechanism for anterior chamber contamination leading to endophthalmitis.

Keywords: cataract • treatment outcomes of cataract surgery • clinical (human) or epidemiologic studies: systems/equipment/techniques