The “stitch or no stitch” controversy in ophthalmology may be ended by an unlikely marriage of ink jet technology and shellfish. “What?” you say Let me explain:
There has been a movement toward sutureless cataract surgery over the last ten years. The main reasons for this movement are that sutures take time to place, can be uncomfortable (during and after surgery), may induce astigmatism, sometimes have to be removed after surgery, can cause an unsightly bleed on the surface of the eye, and are costly. These reasons have led to surgeons even advertising their surgery as “no stitch.” Although sexy, this may not actually be in every patient’s best interest.
There is some evidence that placing a suture may provide additional protection from infection. Since infection is one of the few things that can result in blindness after cataract surgery, this is certainly worth pursuing. However, the risk of infection without a suture is still small (about 1 in 500). With a suture this risk decreases to about 1 in 1000. Thus, in order to prevent one infection 1,000 sutures would have to be placed. Considering the costs of the suture, OR time, additional post-op time removing sutures, etc. the additional amount that would have to be spent to avoid this one infection is somewhere in the $20,000-50,000 range. Granted, it is difficult to place a value on the loss of vision (I would place this value far above $50,000). However, the economic realities being what they are, insurances, the government, and surgery centers are all evaluating these costs very carefully.
Enter the lowly mussel. It’s not just for steaming anymore. Dr. Roger Narayan and colleagues at North Carolina State University have developed a method to use a naturally made “glue” produced by a mussel to seal incisions such as those made during cataract surgery. The trick with using any adhesive with eye surgery is to limit the amount used and to have a smooth surface.
Enter ink jet technology. The same technology used to print your kids photos can be used to finely control the application of a liquid such as the glue derived from mussels. From a cataract surgeon’s perspective this is very exciting technology. Potentially, I could simply spray a bit of mussel glue on the corneal incision at the end of every cataract surgery and achieve all of the following: lower infection risk, fast application, no induced astigmatism, no patient discomfort, no need to remove the suture later, and no unsightly red eye. The real question is “How much will this cost?”
If the manufacturer can get the cost of this technology below $10 per use then cataract surgery can be both sexy and safe.
© 2009 David Richardson, MD