Routine use of a lateral approach to cataract extraction to achieve rapid and sustained stabilization of postoperative astigmatism

After observing that lateral under-riding scleral pocket incisions and closures decayed very little and required full correction on the table to achieve the desired reduction in astigmatism, I began performing routine lateral approaches to planned extracapsular cataract extraction (ECCE). The result was an improvement in early and prolonged stabilization of keratometric astigmatism. This improvement was statistically significant when compared with the identical surgery performed in the vertical meridian. Using a 6.5 mm scleral pocket incision and the same suture material and closure technique, I found that the results of phacoemulsification via vertical and lateral approaches were not statistically different from the planned ECCE via lateral approach. Scleral pocket incisions and modified shoelace closures with 11-0 polyester suture were used in all cases; no suture removal was performed. The early visual recovery with planned ECCE via lateral approach was equivalent to that with phacoemulsification but did not require the expensive instrumentation or the "phaco learning curve." The minimal and stable postoperative astigmatism, along with early and sustained visual recovery possible with ECCE via lateral approach, may reduce the potential benefit of mini-incision and foldable intraocular lens surgery.