The clear corneal tongue: a mechanism for wound incompetence after phacoemulsification.

Purpose: To describe a mechanism for wound incompetence after phacoemulsification with corneal incisions resulting in early postoperative wound leakage.

Design: Observational case series.

Methods: Three patients who had uneventful phacoemulsification through a clear corneal incision were identified because of a postoperative wound leak. A corneal tongue, consisting of an everted triangular flap of posterior corneal stroma, the Descemet membrane, and endothelium, was observed in the wounds of all cases.

Results: One wound leak resolved after pressure patching. The other two necessitated wound revisions. None of the patients developed endophthalmitis.

Conclusions: In phacoemulsification with corneal incisions, an everted flap of posterior corneal tissue, a corneal tongue, may prevent normal anatomical apposition of the surgical wound edges leading to potential wound incompetence. This event may increase the risk of endophthalmitis after clear corneal phacoemulsification.