Safety of air tamponade versus corneal hydration for sealing clear corneal incisions in cataract surgery
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Safety of air tamponade versus corneal hydration for sealing clear corneal incisions in cataract surgery Asimina Mataftsi 1 & Maria Dermenoudi 1 & Artemis Matsou 1 & Argyrios Tzamalis 1 & Periklis Brazitikos 1 & Persefoni Talimtzi 2 & Nikolaos Ziakas 1 & Ioannis T. Tsinopoulos 1 Received: 27 February 2019 / Revised: 4 January 2020 / Accepted: 8 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare safety of wound hydration to anterior chamber air tamponade for securing watertight closure of clear corneal incisions, during uneventful cataract surgery. Methods Prospective, comparative case-control series. Patients undergoing phacoemulsification were assigned to receive either anterior chamber air bubble (Group A) or intrastromal wound hydration with balanced salt solution (Group B) at the end of the procedure. Two high-volume surgeons operated equal number of cases in each group employing identical surgical technique, except for corneal side incision management. Patients were assessed pre- and postoperatively at day 1, day 4, day 9, and day 30 after surgery. Results One hundred eyes of 100 patients were enrolled, of which 2 were lost to follow-up. The two groups were comparable in terms of preoperative risk factor assessment, baseline central corneal thickness (CCT), preoperative endothelial cell density, as well as cumulative dissipated energy and duration of phacoemulsification (p > 0.05). Mean CCT and best-corrected visual acuity were better in Group B on the first postoperative day, but did not differ between the two groups at all other timepoints. Surgically induced astigmatism was comparable in the two groups (p > 0.05). Endothelial cell density loss at 1 month postoperatively was greater in Group A (34.06%) compared to Group B (16.45%). Conclusions Wound sealing with intrastromal hydration proved to be safer than air tamponade in terms of preserving endothelial cell density and function. Keywords Corneal wound hydration . Cataract surgery . Phacoemulsification . Air tamponade
Introduction Clear corneal incisions (CCIs) have been widely in use over the past 20 years in cataract surgery and gradually replaced limbus-based and scleral tunnel incisions [1]. Methods of selfsealing wound construction, as well as methods of sutureless wound closure, have been employed, so as to ensure incision integrity and to minimize fluid ingress and subsequent risk of infection. The size of the main incision is being constantly reduced over the years, but this does not necessarily reflect * Asimina Mataftsi [email protected] 1
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an increase in architecture stability, rather the opposite, as the corneal wound ends up being under more strain and more distorted during the procedure [2]. Air bubble injection to reconstruct the anterior chamber after corneal incisions was found to be efficient in preventing Staphylococcus epidermidis endophthalmitis in an experimental animal model [3]. Air bubble tamponade has been used for the management of Descemet membrane detachment at t
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