Corneal Wound: Architecture and Integrity
Luis E. Fernández de Castro, M.D.1
Helga P. Sandoval, M.D., M.S.C.R.1
Kerry D. Solomon, M.D.1
1 Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
Disclosure: L.E. Fernández de Castro-D: Alcon, Allergan, AMO; H.P. Sandoval-D: Alcon, Allergan, AMO; K.D. Solomon–A,C,D: Alcon, Allergan, AMO, Advanced Medical Research, B&L, InSite Vision,
Eyemaginations
Supported in part by NIH/NEI EY-014793 (vision core) and an unrestricted grant to MUSC-SEI from Research to Prevent Blindness, New York, NY, USA
Introduction
• Surgeons transitioning from larger to smaller micro-incisions
• Incision construction is key for preventing hypotony, wound leaks, and ingress of microorganisms (endophthalmitis)
Purpose
• To compare different incision sizes on clear corneal incision (CCIs) and to determine which incision width creates a square or nearly square arquitecture
Materials and Methods
• A prospective study of 4 human cadaver eyes using different incisions (4) were analyzed– Particular attention was given to ensure that the
wound had a square or near square configuration– Scanning electron microscopy was used to
evaluate wound architecture in each group
3.2 mm 2.8 mm 2.6 mm 2.2 mm
Materials and Methods
• After the CCIs– Corneas were fixed in 2% Cacodylate
Glutaraldehyde– Processed and examined using SEM at the Medical
University of South Carolina, Charleston, SC• Imaging was performed using a magnification factor of
50x, 100x, and 200x• Each specimen was examined and then photographed
according to a standard protocol• The outer and inner corneal wound surface were
evaluated
Results
• Qualitative observations– On the epithelial side• All incisions were
adequately apposed– Large incision width• Rectangle
configuration – Small incision width• Square configuration
3.2 mm Incision
Outer Inner
Epithelial cell loss Apposed Tear of Descemet membrane
Gapping
2.8 mm Incision
Outer Inner
Epithelial cell loss Apposed Gapping
2.6 mm Incision
Outer Inner
Epithelial cell loss Gapping Apposed Tear at the edge
2.2 mm Incision
Outer Inner
Apposed Gapping
3.2 mm
2.8 mm
2.6 mm
2.2 mm
3.2 mm
2.8 mm
2.6 mm
2.2 mm
Larger incision widths prevent a square configuration
Smaller incision widths permit a nearly squared or squared configuration
Conclusion• Larger incision widths often preclude a square
construction due to infringement on the visual axis• Smaller incision width permit a nearly square or square
construction– Square incisions can be more stable than rectangular
• Reducing risk of hypotony• Reducing risk of wound leakage• Reducing ingress of microorganisms
• Irregular apposition and minimal gapping in endothelial edges due to direct mechanical trauma– Clinically shown to improve over time
• Ongoing study to determine wound integrity