Cataract extraction without a conjunctival flap.

Wound healing in 350 cases of senile cataract extraction done with a corneal incision without a conjunctival flap and closed with 3 deep 6-0 chromic gut sutures is examined. There were no cases of epithelial downgrowth and a low incidence of conjunctival blebs. There was one case of endothalmitis and 4 of iris prolapse. Sutures fell out between the 9th and 16th days and the large knots did not cause excessive irritation while in place. There was an 18% incidence of wound leak manifested by shallow or flat anterior chamber. All of these anterior chambers reformed spontaneously soon after the sutures fell out, indicating the wound leak was probably along the sutures tract. One patient with wound leak developed mild glaucoma postoperatively. Wound healing after cataract surgery is discussed. Epithelial downgrowth and conjunctival blebs are related more to tight silk sutures than absence of conjunctival flap. The early loss of the gut sutures does not decrease wound strength since the sutures have already lost their tensile strength. The epithelium which grows into the cataract wound postoperatively when a flap is not used activates stromal fibrocytes and covers any delayed iris prolapse.