Study of incisional leak (IL) in relation to applied point pressure and intraocular pressure (IOP) after clear corneal incisions (CCI)

Session Details

Session Title: Cat Surgery Equipment/inst/OVD

Session Date/Time: Tuesday 16/09/2014 | 16:30-18:00

Paper Time: 17:20

Venue: Boulevard B

First Author: : D.Desai INDIA

Co Author(s): :    A. Desai   V. Desai   S. Shah        

Abstract Details

Purpose:

A good water tight sealed incision is very important for excellent visual results & prevention of endophthalmitis. Incisional leak in post operative period may be due to hypotony, eye rubbing, forced blinking or injury after surgery.This leads to poor immediate visual outcomes and increases the chances of endophthalmitis.It is known that simple eye rubbing can create a pressure of up to 1-2 ounces(oz) in the eye. We performed this study to understand: 1. At what average IOP did the incision not leak? 2. At what point pressure did the incision leak? 3. To compare the effects of age, location of incision and IOP levels on Incisional Leak.

Setting:

All 55 patients underwent Phako Emulsification surgery at Diva Eye Institute by the same surgeon.The(B & L) STELLARIS machine was used and clear corneal incisions were made.

Methods:

In this study we enrolled 55 patients, aged 40-80 years.The 1.8mm primary incision was increased to 2.2mm after IOL insertion.Stromal hydration was done to both the incisions to secure the seal.The IOP was recorded with Schiotz Tonometer using 7.5gm weight.Point pressure was then applied at the incision with a callibrated force gauge. The pressure at which the incision leaked was noted.

Results:

The average IOP where the incision did not leak was 26.4mm of Hg.The superior incision sealed at higher IOP of 30.40mm of Hg when no incisional leak was seen; compared to 25.85mm of Hg for temporal incision. With increasing age increased IOP is required for better seal of incision. The average point pressure was 3.30 oz when IL occurred. The temporal incision withstood more pressure (3.33 oz) compared to superior incision (3.00 oz) for IL.With increasing age we found that the lncision leaked with lesser point pressure. • 63.63% Patients withstood pressure of 3-4 oz • 14.54% Patients of 2-3 oz • 18.20% Patients of 1-2 oz

Conclusions:

The average IOP where no IL was seen was 26.40 mm of Hg.This is satisfactory as it is known this increased IOP will settle to normal range within 15-30 minutes.One may have to increase the IOP in superior incisions compared to temporal incisions.  With increasing age also one may have to increase the IOP for better seal.  The temporal incision(3.33 oz) withstood more point pressure than superior incision(3.0 oz)  With increasing age the eye leaks easily at lower point pressure.  18.20% Patients are at risk even after proper seal of CCI in post-operative period as they could withstand only 1 to 2 oz point pressure.  This indicates that inedvertant eye rubbing ,forced squeezing & slight injury may cause hypotony and eventually poor immediate visual outcomes or even endophthalmitis. This study indicates that it is very important to check properly for IL, whatever the method adopted, using a forced gauge, wet wick or cannula in order to prevent post-operative hypotony & to decrease incidence of endophthalmitis.

Financial Interest:

NONE