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—Dr Girard noted that our study confirms that limbal incisions closed with interrupted 10-0 nylon sutures tend to decay to against-the-rule-induced astigmatism over time. He further suggested that the use of a "scleral tunnel" will prevent such against-the-rule-induced astigmatism. This may indeed prove to be the case. A posterior incision (such as the scleral tunnel) was, in fact, one of several possible approaches we suggested in our article to possibly avoid the long-term drift toward against-the-rule astigmatism seen with superior limbal incisions closed with interrupted 10-0 nylon sutures.Rigorous data to support the utility of the scleral tunnel incision are not, to our knowledge, yet available. As we suggested in our article, any study to validly assess the efficacy of any technique with respect to postoperative astigmatism should prospectively follow up consecutive patients over a long period (2 to 3 years), preferably with vector analysis of the data.
Clorfeine GS, Parker WT. Natural Evolution of Postoperative Astigmatism-Reply. Arch Ophthalmol. 1989;107(7):956. doi:10.1001/archopht.1989.01070020018012