If your phaco incision is properly constructed, it will typically seal quite well without the use of sutures. We can do a mild degree of corneal stromal hydration to assist in sealing the incision. Further closure of the incision is helped by the corneal endothelial pump function and the outward force of the intra-ocular pressure as it pushes the valve of the incision shut.
Another good tip is to use a weck-cel sponge soaked in tetracaine 0.5% and apply it over the incision for 5 to 10 seconds. The tetracaine solution is hypotonic, so applying it over the corneal incision will cause focal swelling of the corneal stroma via osmosis. Do this technique once the intra-ocular pressure has been returned to a normal, physiologic level.
If the incision still has a leak after this technique, then placing a suture to ensure a water-tight incision is often the best bet. No amount of corneal stromal hydration can adequately seal a poorly constructed incision. But sutures can — typically 10-0 nylon.
Click below to learn this technique to help seal your phaco incisions: