ABSTRACT
@#AIM: To present a different approach called dynamic stromal hydration. Though common, conventional hydration technique should be standardized to ascertain wound integrity at the time of stromal hydration during cataract surgery. No explicit criteria exist to suggest that hydration of wound edges is adequate. <p>METHODS: This study was designed as prospective, randomized, comparative study. Leakage sites were detected by continuous irrigation. At that point, stromal hydration was performed in consideration of the leakage points. The wound edges were hydrated until no further leakage could be visually detected. Trypan blue 0.0125% was applied over the wound sites, and each wound was individually observed for leakage. On the day after surgery, Seidel's test was performed to assess wound integrity.<p>RESULTS: All 120 eyes in the experimental group were evaluated, including all 360 wound sites-120 left side ports, 120 right side ports, and 120 main incisions-as were all 120 eyes in the control group. Though the dye test revealed leakage of aqueous humour from only 29 wound sites of 22 eyes(8.0% of 360 wounds)in the experimental group, leakage appeared in 41 wound sites of 30 eyes(11.3% of 360 wounds)in the control group. When groups were compared in terms of leakage, the difference was statistically different(<i>P</i>=0.042).<p>CONCLUSION: Dynamic stromal hydration-meaning standardized conventional stromal hydration-is a direct observational technique that allows the easy evaluation of wound integrity at the time of stromal hydration by way of observing wound dynamics.
ABSTRACT
Objective@#To determine the efficacy of the Wong incision in providing wound seal compared to stromal wall hydration in clear cornea phacoemulsification in cadaveric porcine eyes.@*Method@#This was an in vitro comparative experimental study using ten porcine eyes. All eyes were randomly assigned to the stromal wall hydration (control) or the Wong incision group (experimental). A side port was made and the anterior chamber formed with viscoelastic device. The main incision was made 180 degrees away. In the experimental group, a Wong incision was made first anterior to the main incision. Phacoemulsification surgery with IOL insertion was simulated. The main incision was sealed by hydration. The anterior chamber (AC) was infused with balanced salt solution (BSS) through an AC maintainer and leakage of fluid from the main incision was assessed. Samples from the AC were taken before and after tryphan blue drip and were sent for analysis by UV spectrophotometry. Trypan blue was dripped over the main incision and the whole eyeball was sent for histopathology.@*Results@#There was a significant increase in density from the pre-dye to the post-dye AC samples of the control (0.0052 to 0.0074, p=0.01) and the experimental groups (0.0076 to 0.0094, p=0.02), although the final samples showed an optical density comparable to pure BSS, indicating that there was no significant amount of trypan blue detected in both groups. On histology, trypan blue staining was not seen in the incision tracts of both groups. After infusing the AC with BSS, there was outward wound leakage in all eyes of the control group and none in the experimental group.@*Conclusion@#The Wong incision was as effective as the lateral stromal wall hydration in preventing fluid influx. Furthermore, the Wong incision showed a more stable wound seal against outward wound leakage in an in-vitro porcine model of clear corneal phacoemulsification.