Author Affiliations: Ophthalmic Consultants of Boston, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
Dubey et al correctly emphasize the importance of the wound in preventing endophthalmitis after cataract surgery. Once a sufficient inoculation of bacteria enters the eye, it may not be possible to deliver enough antibiotic to prevent infection. They cite convincing evidence that corneal wounds can imbibe fluid and by implication, bacteria.
I agree that strategies to improve wound closure deserve investigation. Rapid implementation of secure closure is highly desirable. The duration of closure required, before wound healing provides permanent closure, is not defined. While 5 to 6 days seems adequate, it is possible that wounds may leak 7 days and more after cataract surgery. Eye rubbing is a possible mechanism to explain late disruption of the corneal wound.
Raizman MB. Obviating Endophthalmitis After Cataract Surgery: Excellent Wound Closure Is the Key—Reply. Arch Ophthalmol. 2011;129(11):1504-1505. doi:10.1001/archophthalmol.2011.323