SPOTLIGHT ON TECHNOLOGY & TECHNIQUE

ReSure Sealant offers an alternative to corneal sutures

Hydrogel liquid may prevent postoperative fluid egress.

By Bill Kekevian, Senior Associate Editor

For years, cataract patients have run the postoperative risk of fluid egress of the corneal incision, which can lead to lower IOP. One study has shown that lowered IOP can contribute to sutureless clear corneal incisions drawing in contaminants.¹ John A. Hovanesian, MD, of Harvard Eye Associates in Laguna Hills, Calif., says this may explain an increase in infections following cataract surgery when ophthalmologists switched from scleral incisions to clear corneal incisions.

The solution has been to apply sutures in the clear cornea. While most surgeons are quite skilled at suturing, applying microscopic thread to the eye is delicate, time-consuming work — “Like learning to tie your shoes with chopsticks,” Dr. Hovanesian explains. Worse, an exposed knot on the surface of the eye can be painful for patients.

With this in mind, Ocular Therapeutix (www.ocutx.com) developed the ReSure Sealant, a hydrogel technology the FDA recently approved for prevention of postoperative fluid egress.

APPLYING THE SEALANT

ReSure Sealant works like glue for the clear corneal incision. First, the surgeon mixes two drops of a diluent with the dried hydrogel components using a foam-tipped applicator. “You mix it for about 5 seconds and then immediately apply it to the surface of the eye,” says Dr. Hovanesian.

“It will begin setting fairly effectively in about 10 seconds,” he says. “To be safe, you should wait about 30 seconds, but then you’re done. It’s gelled at that point. It’s not going to be washed away by drops or anything else. It typically stays on the eye for one to three days as the wound heals. Eventually, it dissolves or sloughs off.”

COMPARED WITH SUTURES

At the ASCRS meeting in April, Terry Kim, MD, presented a study that compared ReSure Sealant with sutures in postoperative cataract patients. The wound leak rates were 31.7% in patients who received sutures vs. 3.6% in those who received the sealant, as measured by a Seidel test.² The sutures were left in for 28 days whereas the sealant sloughed off in the first postoperative week.

“ReSure reproducibly sealed incisions better than sutures,” says Dr. Hovanesian, one of the study investigators.

EXTRA ASSURANCE

For now, ophthalmologists may restrict its use to “cases where we need extra assurance that the wounds will heal, questions about wound integrity, irregular wounds, or cases with anatomical problems, such as wound burns,” Dr. Hovanesian says. “It may even serve in addition to suture for cases of particularly hard-to-close wounds.” OM

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