title: Recognition and management of internal wound gape.
abstract: We describe a method for recognizing and managing wound gape of the internal aspect of a scleral tunnel incision. The apposition of the cataract internal incision can be adequately assessed with the use of a gonioprism during and after surgery. With self-sealing tunnel incisions, even though the external incision may be well sealed either with or without the use of a suture, the internal incision may be inconspicuously gaping. When an internal incision gapes open, it takes on the appearance of an elongated oval opening by gonioscopy, a process we have termed fishmouthing. Often fishmouthing can be closed by rapidly deepening the anterior chamber with balanced salt solution through the paracentesis incision; if this is unsuccessful, a limbal suture may be required. Assessment of the internal incision with a gonioprism and management of internal incision fishmouthing is an important method to ensure wound stability and minimize surgically induced astigmatism.
authors.affiliation: Gimbel Eye Centre, Calgary, Alberta, Canada.
authors.forename: H V
authors.initials: HV
authors.lastname: Gimbel
authors.forename: R
authors.initials: R
authors.lastname: Sun
authors.forename: B M
authors.initials: BM
authors.lastname: DeBroff
mesh_terms: D000867:Anterior Chamber / Q000601:surgery; D002387:Cataract Extraction; D006068:Gonioscopy / Q000379:methods; D006801:Humans; D011183:Postoperative Complications; D012590:Sclera / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques; D014945:Wound Healing