Is the sutureless cataract incision a valve for bacterial inoculation?

Many cataract surgeons perform sutureless surgery to decrease operating time, postoperative astigmatism, and healing time. Anecdotal case reports of postoperative endophthalmitis after sutureless surgery prompted our investigation of this type of wound closure and its possible relationship to an increased incidence of infection. This in vitro study addressed the question: Is sutureless more likely than sutured cataract surgery to provide a route for inoculation of microbial organisms into the eye? Twenty-eight human eyes obtained postmortem were randomly divided into 14 pairs and successively incubated for 90, 150, 210, and 270 minutes each in a suspension of Staphylococcus epidermidis in physiologic media. Cultured aqueous aspirates yielded no significant differences between sutured and unsutured eyes in colony counts at any time interval. This suggests that both sutured and unsutured wounds resist bacterial ingrowth equally and that a properly constructed unsutured wound is not a significant valve for bacterial inoculation in an eye pressurized to physiological conditions.