Shorstein. He says that's where wound construction and stromal
hydration have been shown to increase the stability of the wound.
Plus, he adds, leaving the eye at an increased pressure is an effective
way to keep the clear corneal flap opposed at the end of surgery.
Dr. Shorstein says cornea sealant has value if there's a posterior cap-
sular rupture. "Although the wound was competent, you want to
make sure, given the rupture, that it's well sealed in the hours after
surgery," he explains. "Surgeons who might have thrown in a stitch to
secure the wound can now use the sealant."
At the end of every case, before he removes the lid speculum, Dr.
Boyd thoroughly checks the wound and adds a suture if there is a
slight leak, which he says is a rare incident that occurs in less than 1%
of cases. He's never used a liquid sealant, but acknowledges that it
could seal the wound effectively. Still, he hasn't felt the need to try it
because he says it's an expensive option and currently unproven to
perform better than a suture.
Positive results
All 21 centers in Kaiser's Northern California region have adopted
antibiotic injections, which have resulted in an endophthalmitis rate
between 1 in 7,000 cases and 1 in 10,000 cases. Dr. Shorstein says the
health system will publish research in an upcoming issue of the
Journal of Ophthalmology that shows a 6% decrease in infection rates
over time based on a retrospective review of the centers in Kaiser's
northern and southern regions. He explains, "We also think that's
because of a greater awareness of the importance of wound construc-
tion and management during and after the procedure." OSM
E-mail dcook@outpatientsurgery.net.
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