From the Guidelines
Side port defects during cataract surgery should be managed promptly with hydration of the wound edges using balanced salt solution to promote tissue swelling and closure, as this approach is crucial in preventing complications and ensuring optimal outcomes in terms of morbidity, mortality, and quality of life. The management of side port defects is critical to prevent postoperative complications such as endophthalmitis, which can be devastating to the patient's vision and overall quality of life 1.
Key Considerations for Management
- Hydrating the wound edges with balanced salt solution is the first step in managing side port leaks, as it promotes tissue swelling and closure.
- For persistent leaks, a 10-0 nylon suture should be placed to secure the wound, or a stromal hydration technique can be used to create edema that seals the defect.
- Post-operatively, patients should receive topical antibiotics, such as moxifloxacin or gatifloxacin, four times daily for one week to prevent infection, as supported by the evidence on reducing the risk of postoperative bacterial endophthalmitis with intracameral antibiotic administration 1.
- A bandage contact lens may be applied for 24-48 hours if the leak persists despite suturing, to protect the wound and promote healing.
Prevention Strategies
- Proper wound construction with appropriate tunnel length (typically 1.5-2mm) and careful instrument handling can help prevent side port defects, highlighting the importance of meticulous surgical technique.
- Patients should be instructed to avoid eye rubbing and swimming for at least one week after surgery to allow complete wound healing and minimize the risk of complications.
- The use of femtosecond laser-assisted cataract surgery (FLACS) may also reduce the risk of side port defects by increasing the precision of corneal incisions, although its cost-effectiveness and overall risk profile need to be considered 1.
From the Research
Cataract Surgery Intraoperative Complication - Side Port Defects
- Side port defects are a potential complication of cataract surgery, and can lead to issues such as wound leakage, iris prolapse, and detachment of the descemet's membrane 2
- The construction of the side port incision is crucial in preventing these complications, and should be made with a 15 degree side port blade, parallel to the iris plane, and with a maximum width of a 20G needle 2
- The incision should be constructed with a pushing force applied along the cutting edge of the blade, to create an internal and external ostium, and should be 0.5mm to 1mm in thickness into the corneal stroma 2
- Studies have shown that different side-port incision configurations can affect the stability of the incision, and that a 2.5 mm squared incision may be the most stable configuration 3
- However, even with a stable incision configuration, there is still a risk of wound leakage and bacterial contamination, which can lead to endophthalmitis 3
- The use of intracameral antibiotics, such as moxifloxacin, can help to prevent postoperative infection, and has been shown to be safe and effective in patients with high-risk characteristics for Covid-19 4, 5