Patient comfort, minimal foreign body sensation support routine use for cataract surgery
A new liquid hydrogel ocular bandage provides improved patient comfort, wound integrity, and closure following cataract surgery.
By Lynda Charters; Reviewed by Matteo Piovella, MD
San Francisco-A new liquid hydrogel ocular bandage (OcuSeal, Beaver-Visitec International) provides improved patient comfort and wound integrity and closure following cataract surgery.
The material is a synthetic hydrogel (85% water) that comes packaged as two separate components-powder and liquid-that are mixed together in a small cylindrical applicator.
“The liquid and powder should be mixed for 5 seconds before use,” said Matteo Piovella, MD, director of the Centro Microchirurgia Ambulatoriale, Monza, Italy. “The solution must be used within 10 seconds.”
When spread over the patient’s wound, the hydrogel film interacts with the underlying tissues and forms a seal that lasts 2 to 3 days. He demonstrated how the hydrogel microstructure comprised holes 2 to 3 µm in size on day 1 postoperatively compared with holes that were 10 µm in size on day 1.
“The epithelium has more room to heal and, eventually, the healed epithelial tissue replaces the [bandage],” he said.
Dr. Piovella and co-author, Barbara Kusa, MD, in clinical practice at the Centro Microchirurgia Ambulatoriale, presented their 4-year experience with the product. During that period, they applied the liquid bandage to the clear corneal incisions of 181 patients (246 eyes; 89 men, 92 women). The mean patient age was 68.57 years. The authors found that the ocular bandage cross-linked within 20 seconds of application and formed a smooth, soft, transparent protective film over the incisions.
No patient experienced discomfort; no complications or adverse effects occurred during the first 6 months postoperatively, Dr. Piovella noted.
There is a learning curve attached to use of the product, and in 16 eyes in this series the ocular bandage was applied incorrectly. In these cases, the application was not accomplished quickly enough because the product polymerizes in 15 seconds, he said.
In 1% of cases, the hydrogel film cannot be applied to the cornea as a result of imperfect mixing of the two components, he noted.
In the 246 study eyes, the best-corrected visual acuity was 0.47 D 1 hour postoperatively and 0.82 D 1 day postoperatively. Only 10% of patients in whom the ocular bandage was applied reported a foreign body sensation 1 day after surgery compared with 70% of patients in whom the bandage was not used.
Any residual ocular bandage that was inadvertently applied disappeared within 12 hours of surgery in all patients.
Dr. Piovella believes that patient comfort during the initial period of healing is an important reason to use this product.
In addition, he noted, studies have implicated unsealed clear-corneal incisions as a possible cause of infections postoperatively. Researchers have suggested that rapid fluctuations in IOP, such as might occur with eye rubbing, can cause unhealed cataract wounds to gape, allowing conjunctival fluid and bacteria into the eye.
The ocular bandage may contribute to wound strength following cataract surgery. A comparison performed in human cadaver eyes with and without the ocular bandage indicated that the average pressure at which incisions burst in eyes in which the ocular bandage was not applied was 59.46 mm Hg compared with 221.84 mm Hg in eyes in which the ocular bandage was applied.
Recently, the manufacturer has tightened up the sterilization parameters and is now filling the powder in an oxygen- and humidity-controlled environment to create better bandage consistency to make application easier. The manufacturer also added a blue tint to improve bandage visibility.
Dr. Piovella now uses the ocular bandage routinely after cataract surgery.
“[The ocular bandage] improves wound integrity and closure after cataract surgery and mostly eliminates the postoperative foreign body sensation,” Dr. Piovella concluded. “Our results support [its] routine use . . . after cataract surgery.”
Matteo Piovella, MD
Dr. Piovella receives lecture fees from Beaver-Visitec International. The liquid ocular bandage is not available in the United States.