Wound integrity of modified anterior stromal hydration Vs. conventional hydration after clear corneal incision phacoemulsification

PURPOSE: To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH). METHODS: Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH (n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing. RESULTS: On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups (P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 – 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups (P = 0.42). More eyes in the ASPH required conversion to CH (n = 4, 13%) due to difficulty in localizing the pocket compared to MASH (n = 0, P = 0.03) CONCLUSION: Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket.