POCKET STROMAL WOUND HYDRATION – A NEW, SAFER TECHNIQUE FOR HYDRATION OF CLEAR CORNEAL INCISIONS AND HOW IT COMPARES TO STANDARD HYDRATION

Hydration of clear corneal incisions at the end of cataract surgery is an important step to improve wound integrity. There are many described techniques, each with their own strengths, but also drawbacks such as cannula slip, healing issues and inducing astigmatism.

We describe a new technique, which we term pocket stromal hydration – we believe this to be a safer and simpler technique to achieve effective hydration which can be quickly adopted by surgeons, particularly in more difficult cases.

Patients undergoing cataract surgery at Newmedica Eye Health Clinic & Surgical Centre - Northampton between 26/04/2024 to 07/06/2024 were included.

The pocket stromal hydration technique will be displayed on video and described. 50 consecutive cases undergoing this procedure were compared against 50 consecutive previous videotaped cases of standard hydration with Rycroft cannula. Presence of wound leakage and cannula slip were assessed (displayed). All patients received standard post-operative drops, and follow up with opticians at 4-5 weeks – complication rates were reviewed through re-referral or self-presentation. Student’s T-test was used to assess statistical significance between groups.

If wound leakage was present in either group, the wound was rehydrated until no leakage occurred as per usual procedure. 12 cases out of 50 (24%) needed rehydration in the pocket hydration group, and 20 out of 50 (40%) in the standard hydration group (p = 0.08805). There was no leakage after complete hydration in either group. No patients were re-referred or self-presented to clinic with wound concerns or leakage in either group. In the standard hydration group, 11 cases (22% of cases) of cannula slip were noted on analysis of video recordings whilst hydrating the roof of the wound (video 2), including one whilst hydrating the roof and angle. There were no cases of cannula slip in the pocket stromal hydration group, giving a statistically significant improvement (p = 0.00026).

Pocket stromal hydration is a safe and simple technique to satisfactorily hydrate clear corneal incisions, with improvement in cannula purchase and therefore significant reduction in rate of cannula slip during hydration.