1. Small Wound Leaks are Associated with Myopic Surprises in Cataract Surgery John A. Hovanesian, M.D. Clinical Instructor, UCLA Jules Stein Eye Institute Harvard Eye Associates, Laguna Hills, California Financial Interest Disclosure: Allergan, Bausch & Lomb, Baxter Bioscience, I-Therapeutix, Johnson & Johnson

2. Hovanesian, 2008 Introduction and Rationale Closure of clear corneal cataract wounds without sutures has become standard of care, yet as many as one third of these incisions may have small leaks at the end of surgery.* These small leaks may allow shallowing of the anterior chamber. This could permanently shift the IOL’s position forward, changing its optical effectivity and inducing myopia. We conducted this study to determine whether wound leaks in cataract surgery are associated with refractive surprises. *Chee SP. Clear corneal incision leakage after phacoemulsification--detection using povidone iodine 5%. Int Ophth 2005; 25:175-9.

3. Hovanesian, 2008 Methods We reviewed records of 50 consecutive patients undergoing cataract/IOL surgery with a Crystalens (Bausch & Lomb Surgical, Aliso Viejo, California) who had seidel negative wounds and 50 who had microscopically undetectable but seidel positive leaks at the end of surgery. Eyes with prior refractive surgery were eliminated. Procedures were performed by a single surgeon (JAH). Postop Management Patch/shield for 4 hours Drops Pred Forte QID Zymar Q2H Acular QID Follow-up refraction at 1 month

4. Hovanesian, 2008 Importance of Wound Closure small wound leak

5. Hovanesian, 2008 Results Compared to target refraction, spherical equivalent at one month was +0.10 +/- 0.65 diopters in the seidel negative group and -0.44 +/- 0.54 in the seidel positive group (P < 0.023). No adverse events or complications of surgery occurred in either group. Seidel Negative Seidel Positive Seidel positive wounds were associated with a mean myopic shift of 0.54 diopters

6. Conclusions Eyes with wound leaks were significantly more prone to develop a myopic surprise after cataract surgery. This suggests the importance of a seidel negative, watertight wound closure. John A. Hovanesian, M.D. (949) 951-2020 drhovanesian@harvardeye.com