I would like to comment on the report by Busin et al1 in the March 1993 issue of the Archives. The authors have shown the advantages of a scleral tunnel incision in inducing very little astigmatism even when no sutures are used. They failed to point out (along with many other authors) that the scleral tunnel incision, which was first described in 1982,2,3 was later4 shown to induce a mean of only 0.34 diopters (D) of astigmatism even when closed with absorbable sutures. The incision was approximately 8 mm long, and a 7-mm posterior chamber intraocular lens was used.
The sclerocorneal tunnel incision has been used in millions of cataract extractions via phacoemulsification. My question is this: should the incision be sutured closed or left unsutured? Reports have shown that the unsutured incision can be opened during trauma.5 Other reports have shown that when the incision
Girard LJ. Long-term Results of Sutureless Phacoemulsification With Implantation of a 7-mm Polymethyl Methacrylate Intraocular Lens. Arch Ophthalmol. 1994;112(5):577-578. doi:10.1001/archopht.1994.01090170021004