Siep’S Test: A Novel Test For Checking Wound Integrity In Small-Incision Cataract Surgery

 The Sieps test can assure a surgeon that he has a watertight wound along with sterilizing the ocular surface at the end of a surgical case. Standard of care for performing routine cataract surgery has become sutureless clear corneal incisions. However, there is concern that leaving incisions in small incision cataract surgery without definitive closure may increase the risk of wound leaks. The procedure is simple and straightforward. It is easily performed, and the findings are accurate. We used this procedure among residents training in intraocular surgeries to detect wound leak after performing the surgery. 

An observational cross sectional study was undertaken at the department of Ophthalmology, in our tertiary eye hospital for a duration span of 12 months (2018-2019). 300 patients who were undergoing Small incision cataract surgery performed by Ophthalmology residents were included.  The study received ethical approval from the institutional and ethical review board of our tertiary hospital following which study was carried out.

All cases were small incision cataract surgery performed by first, second and third year postgraduate students under supervision of the consultant in charge. At the end of the case, the globe is inflated to a normal pressure. The globe is confirmed to be firm by using the finger tension ballottement at the end of the surgery. A drop of paracaine is added just before instilling povidone-iodine. 2-3 drops of povidone-iodine 5% is instilled over the wounds. The leaking aqueous is outlined by the povidone-iodine disclosing the clear flow from the eye, suggesting an aqueous leak.  If any leak was seen it was immediately sutured meticulously. All traces of the povidone-iodine are then washed out to prevent any discomfort to the eye.

Of the 300 patients, 180 were females & remaining 120 were males. 110 had positive sieps test while remaining 190 had negative sieps test. Premature entry comprising (83 cases) 75%, followed by floppy iris syndrome comprising (22 cases) 20% and (6 cases) 5% comprising PXF syndrome. 85 cases which had positive sieps test cases were performed by first year ophthalmology residents, 12 by second year ophthalmology residents & remaining 13 were performed by third year ophthalmology residents.  All these 110 cases underwent immediate suturing for wound leak intra-operatively. With utilizing the sieps test the number of resurgeries drastically dropped from 12 cases in 2018 to 3 cases in 2019 since when we started using this test.

Here sieps test plays an important role in identifying any postoperative wound leaks. The simple procedure is very handy in peripheral areas where getting total asepsis is difficult. Especially among residents this can be a boon where povidone-iodine acts as a riverbank for the outflow of aqueous, outlining the speed, location and quantity of the leak. The additional benefit is that povidone-iodine applied at the end of a surgical procedure sterilizes the surface of the eye. This simple test allows for a quick check on wound integrity and tight closure of the wound. Further it can be used in monocular patients, patients with diabetes or immunocompromised individuals who are at increased risk of infection.