Intrinsic stability of 'self-sealing' unsutured cataract wounds

Many operative and postoperative factors can influence cataract wound stability and postoperative astigmatism. The final outcome is fundamentally dependent on the intrinsic biomechanical stability of the corneal dome in the presence of the wound. We determined the stability of the central and peripheral cornea with computer-assisted topographic analysis of six freshly enucleated human globes. Self-sealing, unsutured, scleral tunnel wounds 4.0 mm in length were dissected, with widths varying from 1.4 to 6.0 mm. Intraocular pressure was elevated in 5-mm increments from 15 to 40 mm Hg without measurable topographic change in the visual axis or superior cornea. We conclude that these long scleral tunnel wounds do not necessarily destabilize the cornea within the usual range of intraocular pressure. Postoperative-induced astigmatism is therefore due to other operative and postoperative factors. Some of these factors may be identifiable with this model and controlled or eliminated.