Reply: Cataract incision closure using fibrin adhesive

Abstract

In their response to the article by Hovanesian and Karageozian, Bellini and Brum suggest that tissue adhesives are not a necessary safety adjunct given proper wound construction and hydration of the incision tissue. As part of their assertion, they mention the study1 that Belani and I published regarding wound integrity and the absence of hypotony when incisions were constructed to be square in their surface architecture, were unstretched during surgery, were hydrated, and were tested for water-tight sealing at physiologic intraocular pressures. Indeed, our study demonstrated that clear corneal incisions can be fashioned in a safe manner, and we genuinely appreciate the reference to our work. Nevertheless, the purpose of our study was to determine whether clear corneal cataract incisions might be hermetically sealed if appropriately constructed and managed. As a result, we have full confidence in that method of wound management. It was not our intention to preclude the use of additional safety tools, such as tissue adhesives, when fully tested, safe, and widely available. To the contrary, we encourage their development. Bellini and Brum emphasize the importance of careful incision management, which will not be abrogated when adhesives are generally available.