Ocular Bandages

The opportunity to improve patient comfort together with the potential to reduce the risk of postoperative endophthalmitis by improving incision integrity provides a rationale for routinely sealing clear corneal incisions with a hydrogel ocular bandage after cataract surgery, said Matteo Piovella MD, at the 26th Asia-Pacific Association of Cataract & Refractive Surgeons Annual Meeting.

Dr Piovella, medical director, Centro Microchirugia Ambulatoriale, Monza, Italy, reported on his four-year experience using hydrogel ocular bandages (ReSure Adherent Ocular Bandage, Ocular Therapeutix and OcuSeal Liquid Ocular Bandage, Beaver Visitec International). He noted that he was initially impressed by analyses he conducted showing that use of these products significantly reduced patient reports of foreign body sensation on postoperative day one, and did so without compromising early visual recovery or causing any other adverse events. However, his decision to incorporate a hydrogel ocular bandage into his standard surgical protocol was fortified by experimental and clinical findings indicating that these products increase EUROTIMES | Volume 18 | Issue 11 the watertight properties of the surgical incision. Dr Piovella said that he is now using a hydrogel bandage in all cases excluding those with significant epithelial loss where the product will delay ocular surface recovery. For patients having bilateral surgery, Dr Piovella uses one of the commercially available products in the first eye and the other for the fellow eye procedure. “It is very difficult to prove scientifically that a hydrogel ocular bandage reduces the risk of post-cataract surgery endophthalmitis. However, if it does prevent these horrible infections by preventing incision leakage, I am protecting my patients. And in using these products, I am at the least serving them better by giving them greater comfort,” said Dr Piovella.

Several lines of evidence indicate that the hydrogel bandage products protect against corneal incision leakage. In a cadaver eye study, researchers from the Moran Eye Institute, University of Utah, Salt Lake City, reported that the mean IOP at which leakage occurred was increased significantly and by more than three-fold in eyes with corneal incisions closed with the OcuSeal bandage compared with untreated controls. In a controlled clinical trial, findings from postoperative OCT imaging, IOP measurements and Seidel testing were consistent in supporting the conclusion that use of the ReSure ocular bandage prevented incision microleaks. In addition, Dr Piovella reported his observation that the anterior chamber depth achieved after BSS inflation at the end of the cataract surgery case is increased when the incision is sealed with a hydrogel ocular bandage.

Dr Piovella acknowledged that there are barriers to more widespread adoption of the hydrogel bandages. Cost is an issue as is the logistics of their use, which involves precise timing for mixing the components together and applying the final solution onto the cornea before the material begins to polymerise. In fact, he reported that in a study of one of the products enrolling 256 eyes, the material could not be applied in two per cent of cases due to imperfect mixing of the components and in another six per cent because it was not applied fast enough after mixing. “Surgeons should anticipate a learning curve for using these products and to sometimes need a second attempt. However, they should be open-minded because the learning curve is not too difficult or too long,” Dr Piovella said.