Watertight Closure in Corneal Incisions Sealed With Hydrogel Sealant

Cataract, Surgery (Photo By BSIP/UIG Via Getty Images)
Patients who used the hydrogel saw the best responses after a combined cataract and glaucoma procedure for closure of clear corneal incisions.

A hydrogel sealant is superior to sutures for closure of clear corneal incisions (CCI) following combined glaucoma procedures, according to a retrospective case series published in Clinical Ophthalmology.

The standard of practice wound closure for CCI is sutures. But recently, clinicians are paying stricter attention to postsurgical wound closure, as insufficiently closed surgical wounds increase the patient’s risk for infection, and 24% to 34% of sutured wounds leak even under minimal strain.

Patients (N=452) who underwent combined phacoemulsification and glaucoma surgical procedures at the Duke University Eye Center between 2013 and 2019 were included in this study. Stratified by receiving a ReSure hydrogel sealant (Ocular Therapeutix (n=305) or suture (n=147) CCI closure, the sealing strategies were evaluated for wound leak.

The most common combined procedures were trabeculectomy with Ex-Press® (Alcon) shunt (55.1%), Baerveldt tube (20.8%), and trabeculectomy (13.7%).

No patient who received ReSure hydrogel sealant experienced a wound leak event at postoperative day 1.

In the suture cohort, 3 patients had a leak event determined to be spontaneous Seidel positivity of the CCI on postoperative day 1. These rates indicated that suture recipients had a 2.04% increased rate in wound leak (P =.0124).

Among the 3 cases of wound leak, 2 received phacoemulsification and trabeculectomy with Ex-Press shunt procedures and one a combined phacoemulsification and Baerveldt® tube procedure (Johnson & Johnson Vision). Anterior chamber depth was not associated with wound leak, in which all three patients had deep, well-formed anterior chambers. No correlation between age and wound leak was observed.

This study had limited power and was unable to assess for differences in the rate of endophthalmitis which is the chief concerning complication in this setting.

The study investigators concluded that regardless of complexity, ReSure hydrogel sealant maintained a watertight CCI closure and did not leak in any case. These findings may indicate that the standard closure strategy of using sutures should be reevaluated.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Machiele RD, Guduru A, Herndon LW. Hydrogel sealant for closure of clear corneal incisions in combined glaucoma procedures. Clin Ophthalmol. 2022;16(3):861-865. doi:10.2147/OPTH.S354531