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

Abstract

Wound leak has been demonstrated in 31% of clear corneal incisions (CCIs) at the conclusion of phacoemulsification surgery. 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. The side port is rehydrated. The patient is asked to look in the direction opposite that of the leaky port (for a main port leak in a temporal route phacoemulsification, the patient would be asked to look nasally), causing the air bubble to float up and tamponade the incision internally (Video, available at http://jcrsjournal. org). This position is held for 15 seconds, and the patient is then asked to look straight ahead. The surgeon should carefully observe the bubble for constancy of size. If the bubble size remains constant, the wound is watertight. If the bubble size progressively increases for a few seconds, there is a leak from one of the ports. In this case, the leaking port is identified, the dynamic air bubble sealing procedure is repeated, and the bubble is reexamined for constancy of size. This technique obviates the need for repeated incision hydration and the risk for increased intraocular pressure.It has been demonstrated that CCIs have pouting inner lips, and these may be responsible for the imperfect watertight sealing by stromal hydration; up to 30% show a gape in the endothelial side on the first postoperative day. 2,3 In such a case, the gaping incision lips would need positive pressure to close, which an air bubble pushed against the inner ostium of the incision would provide by its buoyancy.In accordance with the Boyle law, the volume of the air bubble in the anterior chamber depends inversely on the pressure in the chamber. In the case of a leaking corneal wound, the pressure in the anterior chamber would decline and the air bubble would continue to expand. This is a definite indication of even a slight wound leak. 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. 1These 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. Additionally, the air bubble used in our technique is too small to cause visual obscuration, pupillary block, or significant endothelial damage. REFERENCES1. Chee S-P. Clear corneal incision leakage after phacoemulsificationddetection using povidone iodine 5%. Int Ophthalmol 2005; 26:175-179 2. Fine H, H...

Ciliary sulcus implantation of intraocular lens in manual small incision cataract surgery complicated by large posterior capsule rupture

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Intracameral air bubble tamponade in routine cataract surgery

“…14,15 IABT has also been reported as a special technique to prevent ocular surface uid in ow at the end of sutureless cataract surgery and to prevent postoperative corneal edema. [16][17][18] Moreover, air bubble in AC after cataract surgery can even decrease the rate of DMD when displayed in detail with anterior segment optical coherence tomography. 19 While in experiential animal models, it has the capability to reduce intraocular in ammation, and to prevent endophthalmitis.…”