The clear corneal incision (CCI) is arguably the most popular wound construction technique for modern cataract surgery. Preferred for their self-sealing properties, CCIs avoid induced astigmatism and excessive bleeding in the majority of cases. I typically construct a CCI and use a liquid ocular bandage for added protection.
Of the two hydrogel liquid ocular bandages commercially available in Europe, I use OcuSeal (Beaver-Visitec International, Ltd., Oxfordshire, United Kingdom; Figure 1) to ensure safe closure of CCIs after cataract surgery. Within 20 seconds of applying OcuSeal to the ocular surface, the crosslinked liquid forms a smooth and transparent barrier to protect the corneal incision from microbial infection, allowing the incision to heal and possibly providing added protection from endophthalmitis. The bandage, undetectable by slit-lamp evaluation just hours after application, lasts for 1 to 2 days. It degrades and disappears from the incision site within 4 days, coinciding with recovery of the epithelium and formation of new tissue at the wound site.
OcuSeal is supplied as two components, a powder polyethylene glycol and a liquid polyethylene amine. When mixed and shaken for 5 seconds, they form the hydrogel bandage. This bandage can then be applied directly to the ocular surface.
TIPS
For a video demonstration of the use of OcuSeal, visit http://eyetube.net/?v=nenik. There is a short learning curve associated with the use of OcuSeal. I noticed some difficulty in applying the bandage quickly enough. Because OcuSeal polymerizes in 15 seconds, it is imperative that application occurs as soon after the two components are mixed as possible to avoid a surplus of OcuSeal on the wound.
Another hiccup can occur if too much OcuSeal is applied to the ocular surface, which can result in mild foreign body sensation immediately after surgery. (This event was mainly due to the learning curve associated with the proper mixing time.) However, in most cases the patient’s eye blinking is enough to remove the excess within 12 hours after application. If too much OcuSeal is applied, it is possible to remove the surplus immediately with a sponge and start again with a new application.
CLINICAL EVALUATION
We recently conducted a study of 123 eyes (91 patients) in which the OcuSeal hydrogel liquid bandage was applied to the CCI of one or both eyes at the end of routine cataract surgery. The incision size was approximately 2.8 mm in most cases. When we implanted the Synchrony IOL (Abbott Medical Optics Inc., Santa Ana, California), we enlarged the incision to 3.75 mm. There were no adverse events, and the sealed wound appeared to increase patient comfort, with only 15% of patients reporting foreign-body sensation 1 day after surgery. However, in the 63 eyes that had unilateral application, 70% reported foreign-body sensation in the eye without OcuSeal. These results are based on the fact that any corneal incision creates some amount of damage to the epithelium.
Additionally, it appears that applying OcuSeal to the wound blocks the CCI from letting infectious bacteria into the eye, thus decreasing the risk for endophthalmitis.
Matteo Piovella, MD, is Director of the Centro di Microchirurgia Ambulatoriale, Monza, Italy. Dr. Piovella states that he is a consultant to Abbott Medical Optics, Inc., and Beaver-Visitec International. He may be reached at tel: +39 039 389 498; e-mail: piovella@piovella.com.
