Clear corneal incision leakage after phacoemulsification––detection using povidone iodine 5%

Abstract

The purpose of this work was to study the incidence of clear corneal wound leakage at the conclusion of standard co-axial phacoemulsification in a prospective observational series of 100 consecutive cataract cases in a single surgeon's institutional practice. At the conclusion of standard co-axial phacoemulsification using a 2.75 mm temporal single plane clear corneal incision with a 1 mm clear corneal side-port incision, the wounds were hydrated and checked for water-tightness. Povidone iodine 5% (P-I) was then evenly dripped over the cornea and the wounds were inspected visually. Any leakage of aqueous observed was recorded. The amount of leakage was graded as small or large from each wound. Leaky wounds were further hydrated and retested with P-I until sealed. Wound integrity was reassessed on the first postoperative day by use of fluorescein. Of the 100 cases, wound leakage was observed for 31 eyes (31%)-ten main incisions, nineteen side-port incisions, and both incisions in two cases. Wound leakage was easily detected as a ribbon of clear fluid streaming from the incision amid a pool of brown solution. Povidone iodine was not observed within the tract in any incision. All wound leakage was small except for one from the main incision and two from the side-port incision. None of the eyes developed wound leakage the day after surgery and none developed endophthalmitis. In conclusion, leakage from clear corneal incisions at the conclusion of phacoemulsification occurs in almost a third of cases, predominantly from the side incision. It is easily detected by use of the P-I test.

Efficacy of three different methods for side port incision wound sealing

“…In addition, it has been shown that multiple instrument insertions and excessive manipulation may distort the incisions, thereby increasing the likelihood of inflow and/ or leakage during the postoperative period (8) . Chee et al demonstrated a high incidence of side port incisions leakage after phacoemulsification (9,10) . Such leakage may lead to bacterial contamination and thus potentially to infection.…”

“…Chee et al performed intraoperative stromal hydration in an attempt to seal leaking incisions. However, they observed that if the incision was overly manipulated, leakage persisted regardless of the hydrosealing (9) . Moreover, the hydrosealed wound is more susceptible to local Descemet membrane detachment than without hydration 18 .…”

Simple technique for sealing clear corneal wound leaks using a dynamic anterior chamber air bubble

“…1 We describe a technique for effectively sealing a clear corneal wound with subsequent confirmation of a watertight seal.Clear corneal phacoemulsification is performed under topical anesthesia, and surgical ports are hydrated. If the wound is leaky, an air bubble is injected into the anterior chamber through the side port so the bubble's diameter is one third to one half the corneal diameter.…”

“…1 We describe a technique for effectively sealing a clear corneal wound with subsequent confirmation of a watertight seal.…”

“…Prominent among the techniques described to detect wound leak are direct observation of escaping air or aqueous, viewing the movement of any particles in the anterior chamber, and use ofpovidone-iodine 5% to perform an on-table Seidel test. 1 These have drawbacks such as the high surface air tension giving the false impression of a watertight wound whereas it is only airtight, the risk of missing a minimal leak, or the need to use a potentially toxic chemical such as povidone that might be sucked into the anterior chamber. 1,4 Our technique obviates these disadvantages.…”