Objective: Clear corneal cataract incisions without sutures allow for rapid visual rehabilitation after phacoemulsification but might be associated with an increased risk of postoperative infection. The goal of this study was to examine in vitro dynamic changes in unhealed clear corneal cataract incisions that might adversely affect the risk of intraocular infection. Design: Laboratory investigation. Methods: Self-sealing clear corneal incisions were created in cadaveric human and rabbit eyes, and intraocular pressure was controlled with an infusion cannula. Incisions were imaged in real time using optical coherence tomography as intraocular pressure was varied. Using an artificial anterior chamber, India ink was applied to the surface of cadaveric human corneas with clear corneal incisions to detect possible flow of surface fluid along the incision. Intraocular pressure was varied by raising and lowering the infusion bottle so as to simulate the variation in intraocular pressure that would occur with successive blinks. Results: Optical coherence tomography demonstrated variation of corneal wound morphology in response to changes in intraocular pressure. Higher intraocular pressures were associated with close apposition of the wound edges, with no tendency for wound leakage. At low intraocular pressures, however, wound edges tended to gape, starting at the internal aspect of the wound. One incision opened along the entire length, allowing fluid flow across the cornea. Histologic examination revealed India ink particles in all incisions for up to three fourths of the length of the wound. Conclusions: Transient reduction of intraocular pressure might result in poor wound apposition in clear corneal incisions, with the potential for fluid flow across the cornea and into the anterior chamber, with the attendant risk of endophthalmitis.
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