I acknowledge Girard's reports on the use of a scleral tunnel for intraocular lens implantation. However, his claim that closing the tunnel with absorbable sutures might offer advantages over a sutureless tunnel does not seem justified. Traumatic wound ruptures, endophthalmitis, and a gradual drift of astigmatism toward "against the rule" are also seen after conventional cataract surgery with sutured corneoscleral wounds. Only a randomized study involving a large number of patients operated on by the same surgeon could show any statistically significant difference between sutureless and conventional catract surgery in regard to the incidence of these complications.The only report by Girard and coworkers1 available to me included a relatively small number of patients (36) with a mean follow-up of 6.6 months (range, 3 to 15 months). All patients underwent pars plana lensectomy, vitrectomy, and intraocular lens implantation through a scleral tunnel that was finally closed with
Busin M. Long-term Results of Sutureless Phacoemulsification With Implantation of a 7-mm Polymethyl Methacrylate Intraocular Lens-Reply. Arch Ophthalmol. 1994;112(5):578. doi:10.1001/archopht.1994.01090170021005
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