Dynamic morphology of sutureless cataract wounds - Effect of incision angle and location

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 endoplithalmitis. The purpose of this study was to evaluate the effect of intraocular pressure (IOP), location, and angle of cataract incisions on wound apposition and scaling 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 lop was varied by raising and lowering the infusion bottle, so as to simulate the variation in IOP occurring with blinking or squeezing of the eve. Results: With each type of incision, optical coherence tomography demonstrated the dynamic nature of cataract wound morphology as lop was varied. Higher lops, 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 lop; At lower lops, 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 lop. (C) 2004 Elsevier Inc. All rights reserved.