Scleral-flap incision for cataract surgery

I present a technique for creating a three-stage scleral incision for extracapsular cataract extraction and intraocular lens (IOL) implantation, especially useful for cases in which phacoemulsification is contraindicated or aborted. The incision is 5 to 10 mm wide, and the scleral flap is trapezoidal and requires one to three horizontal sutures for closure. The technique was used in 364 consecutive eyes; follow up was 6 months. After 1 week, 80% of these eyes had 1.50 diopters or less of induced keratometric cylinder; at 1 month, 70% had less than 1.00 D. At 6 months, 87% had 0.50 D of against-the-rule cylinder. Less than 6% had elevated intraocular pressure (22 to 28 mm Hg); hyphema developed in 7%. Forty-nine percent had 20/40 or better vision in 1 week; 75% achieved this acuity at 1 month. Final refractions in 87% of the eyes at 6 months were -1.00 (+/- 0.75) + (+/- 1.00) x 180 degrees. This technique provides most of the benefits of small-incision cataract surgery, including rapid, stable visual recovery. IOLs of any optical size can be implanted.