Sealing clear corneal incisions in cataract surgery

Introduction: Clear corneal incisions (CCIs) are increasingly being preferred by surgeons owing to ease of construction, minimal astigmatism and faster visual rehabilitation. However, postoperative IOP fluctuations may result in poor wound apposition and ingress of ocular surface fluid. Effective sealing of CCIs is essential to prevent postoperative wound leak and its consequences, such as hypotony and endophthalmitis. Areas covered: We herein reviewed the different methods of sealing clear corneal incisions, along with their pros and cons. All relevant articles identified after a comprehensive Medline search using 'clear corneal incisions', 'cataract incisions' and 'phacoemulsification incisions' as keywords were included for qualitative synthesis. Expert commentary: Incision architecture is the most important factor determining effective wound sealing. Stromal hydration is the most widely preferred method of wound closure, and is most feasible to employ in daily clinical practice. Though suture-assisted closure is not the first choice to seal the wound, its utility will persist in complicated cataract cases and paediatric cases. Hydrogel sealants are emerging as a superior alternative to sutures and stromal hydration in terms of tensile strength and wound sealing ability. A well-constructed corneal incision may be effectively sealed with any of the currently available methods without significant adverse effects.