Cataract incision closure using fibrin adhesive

Abstract

Despite the interesting results in Hovanesian and Karageozian's article1 on watertight cataract incision closure using fibrin tissue adhesive, we would like to make the following comments. First: In addressing the issue of postoperative endophthalmitis, ingress of fluid into the anterior chamber seems to be more relevant than fluid egress. To diminish fluid ingress, most cataract surgeons prefer to end the surgery with normal or slightly high intraocular pressure (IOP). Moreover, low IOP (hypotony) is not desired at the conclusion of cataract surgery because it may be a risk factor for endophthalmitis.2 In addition, a proper clear corneal wound of square surface architecture seems to be stable postoperatively, as demonstrated by the absence of hypotony and wound leakage in a recent study.3 Despite these data, Hovanesian and Karageozian tested fluid ingress under low IOP. Regarding this, we think the most important question to address is whether there is any difference in fluid ingress between the 2 groups (with and without fibrin adhesive) under normal or slightly high IOP. We do not think there is. Second: Stromal hydration of clear corneal incisions reduces fluid ingress into the anterior chamber at the end of the surgery.4 However, we assume this method was not used by the authors since they did not mention it. So, another important question is whether there is any difference in fluid ingress between the 2 groups when stromal hydration is used and the surgery ends under normal or slightly high IOP. We do not think there is. Third: Randomized and blind studies are methodologically more appropriate to evaluate this issue since there is potential bias involved. We hope our suggestions lead to further investigations.