Horizontal anchor suture closure method for small incision cataract surgery

A modified circumferential suture closure system (horizontal anchor suture) was used with scleral pocket incisions between 4.0 mm and 7.0 mm in length, phacoemulsification, and foldable or rigid posterior chamber intraocular lenses in 120 eyes. The cases were divided into three incision size groups: 4.0 mm, 5.0 mm, and 6.0 mm or greater. An additional group of patients received foldable lenses through a 4.0 mm incision that was not sutured. The postoperative results and astigmatic analyses revealed that the suture method created physically stable, watertight incisions, with minimal transient with-the-rule induced astigmatism for all groups. The longer the incision, the greater the eventual against-the-rule iatrogenic change from presurgical astigmatism. The group without suture closure also obtained a physically stable incision; however, no transient with-the-rule postoperative astigmatism was observed. Instead, a progressive but small against-the-rule astigmatic change was noted. This suggests that unsutured incisions longer than 4.0 mm may create significant postsurgical against-the-rule changes from presurgical astigmatism. Unless surgery is performed in the steepest corneal meridian, undesired changes in astigmatism will likely accompany surgery in cases without sutures when incisions greater than 4.0 mm are used.