A high-stability, one-stitch W incision for cataract surgery

We describe a technique to create a highly stable, one-stitch incision for use with rigid posterior chamber intraocular lenses (IOLs). Inverse U and W incisions are compared in 203 consecutive eyes with 3 months follow-up. A scleral groove resembling an inverted W is dissected away from the limbus, and the anterior chamber is entered by a conventional tunnel technique that resembles a frown incision but has an additional triangular, central scleral flap. When the incision is closed, a single stitch is placed through the flap, away from the limbus. Advantages of the W incision include reduction and control of astigmatism, improved self-sealing, reduced postoperative leakage, no special suture-material requirements, high mechanical stability, easy extendability for extracapsular cataract extraction or trabeculectomy, and intraoperative sealing of a leaking irrigation/aspiration opening by inverting the flap. The W incision offers high stability and multiple advantages over the frown incision and is suitable for use with rigid posterior chamber IOLs.