[Sutureless wound adaptation. Comparison between corneal and corneoscleral incision]

Fifty-four eyes with concomitant diseases, either a coagulation disorder or previous glaucoma surgery, were implanted with a folded, disc-shaped silicone intraocular lens (IOL) via a 3.5 mm three-step clear corneal tunnel; we developed this technique in 1991. IOLs of the same lens type were implanted through a 3.5 mm corneoscleral tunnel by the same surgeon in a control group consisting of 52 eyes. The final visual outcome was reached after 4 weeks in 44.7% of the patients (compared to 63.5% in the control group). The postoperative astigmatism stabilized after 3 months in 31.4% of the patients belonging to the clear corneal tunneling group and after 1 month in 32.1% of the patients belonging to the corneoscleral tunneling group. Compared to the control group, the continuously decreasing induced astigmatism was significantly greater in the clear corneal tunneling group at all times, except for 1 week postoperatively. After 1 year, the mean astigmatism was 0.91 +/- 0.50 D, compared to 0.57 +/- 0.36 D in the control group. After 18 months, the average induced astigmatism in the clear corneal tunneling group increased to 1.30 +/- 0.54 D, compared to the stable value in the control group amounting to 0.59 +/- 0.52 D. As an alternative to routine corneoscleral small incision surgery, the clear corneal technique is especially suited for patients with a coagulation disorder, with unfavorable anatomic conditions, or with glaucoma; a scleral incision should be avoided in these cases.