Unintentional filtration after cataract surgery.

The eyes of an 81-year-old man were obtained three and ten days after intracapsular extractions had been made through limbal incisions under limbal-based flaps of conjunctiva and Tenon's capsule. The wounds were closed with 7-0 chromic collagen. Before death from bronchopneumonia, the patient developed bilateral filtrations in association with violent coughing spells. In both specimens, the healing processes of the conjunctiva and Tenon's capsule were advanced, confining the escaping aqueous humor to the subepithelial tissues of the flap. In contrast, the stromal wounds were still inert in accordance with our earlier observations that these wounds are precariously weak during the first two weeks after surgery. In cataract surgery, flaps including both conjunctiva and Tenon's capsule should be prepared and closed to support the slower healing stromal wound. Prevention of filtrations is not a simple matter of using many sutures. This patient's eyes demonstrated that improperly placed or too tightly tied sutures may be directly responsible for leaking wounds.