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To the Editor.
—A scleral flap incision technique reduces postoperative astigmatism but can increase the incidence of hyphema during the first day after cataract surgery. Factors that decrease this occurrence are as follows: (1) The scleral flap should measure 2 to 3 mm from the limbus to the posterior flap edge. Flaps extending further posteriorly are more likely to cause hyphemas. My initial 25 to 30 scleral flaps measured 4 to 5 mm, and the incidence of hyphema was over 50%. With narrow flaps, hyphemas still occur, but at a 3% to 4% rate. (2) The lateral wound edges should be sutured securely. A suture within 2 mm of each wound extremity will assure tightness. (3) With each suture, after the needle passes through the flap, the needle should pass into the scleral bed and then posteriorly. This prevents mobility of the flap on the scleral bed. The formation of
Moses L. Postoperative Hyphema in Cataract Surgery With Scleral Flap Technique. Arch Ophthalmol. 1986;104(6):793. doi:10.1001/archopht.1986.01050180023003