[Minimizing astigmatism by controlled localization of cataract approach with the no stitch technique. A prospective study]

BACKGROUND

The no-stitch-technique with deliberate localisation of the cataract incision is a method to reduce the postoperative astigmatism. This prompted us to investigate the postoperative astigmatism with varying incision localisation; our aim is to achieve a postoperative astigmatism < or = 1.0 D.

PATIENTS AND METHOD

In this study we controlled 319 eyes of 316 cataract patients. We took into consideration the preoperative astigmatism and operated in the 12 o'clock or lateral position. The astigmatism was measured by an ophthalmometer preoperatively, on the first day, after 3-5 months and 8-12 months after surgery.

RESULTS

A preoperative astigmatism of up to < or = 1.0 D was present in 82.4% of eyes. On the first day after surgery an astigmatism of < or = 1.0 D was present in 89.3% of eyes. After 3-5 months postoperatively astigmatism was < or = 1.0 D in 97.2% and in 98.8% after 8-12 months postoperatively. 15.7% of patients showed a preoperative astigmatism between 1 and 2 D, but only 1.2% after 8-12 months. There was no astigmatism > 2.0 D after 3-5 months and 8-12 months (preoperative 2%).

CONCLUSIONS

The no-stitch-technique permits to control the postoperative astigmatism with deliberate localisation of the cataract incision. Postoperative astigmatism appeared to be stable. We therefore recommend for preoperative "ATR (Against the rule)-Astigmatism" (> or = 1.0 D) operation in lateral position and for preoperative "WTR (With the rule)-Astigmatism" operation in the 12 o'clock position.

Resource management of cataract patients: effect of four contemporary incisions on postoperative visits required

PURPOSE

To assess the effect of four contemporary cataract surgery incisions on the number of postoperative visits required.

SETTING

Cataract service of a large free-standing eye hospital in a capital city.

METHODS

This study comprised a prospective evaluation of three incisions for phacoemulsification and a retrospective assessment of age- and sex-matched patients having conventional corneal section extracapsular cataract extraction. All patients had age-related cataract. Main outcome measures were complications, best corrected and uncorrected visual acuities 6 weeks after surgery, and number of visits before discharge. Follow-up was at least 6 months.

RESULTS

Patients who had small and scleral incisions had better uncorrected visual acuities 6 weeks postoperatively because they had less astigmatism. Patients who had small and scleral incisions required significantly fewer postoperative visits before discharge.

CONCLUSION

A prospective assessment of the feasibility and acceptability of reduced postoperative follow-up after phacoemulsification using a scleral tunnel is required.

Penetrating keratoplasty with donor and recipient corneas of the same diameter

BACKGROUND AND OBJECTIVE

A retrospective study was conducted to investigate the effect of penetrating keratoplasty (PK) with donor and recipient corneas of equal diameter on astigmatism, corneal curvature, and spherical equivalent.

PATIENTS AND METHODS

A total of 89 eyes of 86 consecutive patients who underwent PK with donor and recipient corneas of equal diameter were studied. The surgical techniques were performed using the Hanna suction punch block (endothelial cut) with the trephine system, and a single running 16-bite 10-0 nylon suture. Sixteen eyes underwent a triple procedure (PK, extracapsular cataract extraction, and intraocular lens [IOL] insertion) and 14 eyes underwent PK with sulcus fixation of a posterior chamber IOL. Follow-up ranged from 12 to 30 months (mean +/- SD 17.5 +/- 4.7). The sutures were removed at approximately 12 months postoperatively.

RESULTS

The postoperative astigmatism ranged from 0.4 to 10.8 D (mean +/- SD 4.5 +/- 2.8), as evaluated by a computer-assisted videokeratograph topography unit. Twenty-seven eyes (30.3%) achieved a refractive error (spherical equivalent) within +/- 1.5 D of emmetropia. The mean postoperative refractive error (spherical equivalent) was -0.1 +/- 3.5 D (range -6.75 to + 7.25). No wound dehiscences or glaucoma was noted during the follow-up.

CONCLUSION

The Hanna suction system creates a sharp, deep, and perpendicular cut on both button cornea and host cornea, making it possible to use donor and recipient corneas of the same diameter in PK with good clinical and refractive results, particularly for myopic (keratoconus) patients.

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.

Holmium:YAG laser thermokeratoplasty to correct hyperopia: two years follow-up

BACKGROUND AND OBJECTIVE

Treatment of hyperopia is more of a challenge than PRK but the development of the holmium:YAG laser has provided a more controlled way of carrying out laser thermokeratoplasty (LTK).

PATIENTS AND METHODS

Twenty two eyes with hyperopia were treated with a Summit Technology OmniMed holmium laser by placing two rings of eight laser spots at 6.5 and 9 mm (centred on the visual axis) to produce a 4.00 diopters (D) correction.

RESULTS

An average +2.10 D refractive correction was achieved in the 17 eyes with no induced astigmatism with an accuracy of 25% within 1.00 D, 60% within 2.00 D and 100% within 3.00 D. However, significant astigmatism (+1.25 to +2.5 Dcyl) was produced in 23% of eyes from 6 months post-laser and these required astigmatic LTK correction.

CONCLUSIONS

The overall results were disappointing in that there was an approximate 50% regression at two years post-LTK. However, the rate of regression was very slow at 24 months, and most patients remarked how well they could see in the first few months following the treatment.

Methods to control astigmatism in cataract surgery

The correction of astigmatism during cataract surgery has evolved due to recent basic and clinical studies. To control surgically induced astigmatism, the surgeon has many options, including varying incision parameters, astigmatic keratotomy, scleral flap recession and resection, toric intraocular lens implantation, and modifying postoperative medical treatment. The recent literature is reviewed, and our current approach for cataract surgery is discussed.

Corneal topography in cataract surgery

Keratometry and corneal topography remain the most important means of evaluating induced corneal changes after surgery and have comparable sensitivities in the paracentral region of the cornea. However, keratometry gives no information about the peripheral cornea or about asymmetry of the cornea. Videokeratography should be performed after cataract surgery in cases in which best-corrected visual acuity is not adequate and there are no other obvious causes for poor vision to determine whether corneal irregularities are present. The recent literature on corneal topographic evaluation of induced astigmatism after cataract surgery suggests that in general, smaller, temporal incisions result in less astigmatism. Preoperatively, corneal topography can be used in the calculation of intraocular lens power as well as incision planning. Postoperatively, it can be used to detect tight sutures, torsion of the wound, internal wound gape, and irregular astigmatism, as well as to guide suture removal. In the future, corneal topography will become increasingly important in the determination of intraocular lens power in difficult cases such as patients undergoing combined cataract extraction and penetrating keratoplasty as well as patients with a history of radial keratotomy or photorefractive surgery.

[Corneal astigmatism after refraction keratotomy]

Refraction keratotomy, by changing corneal refraction, may cause postoperative astigmatism, including its reverse form. The author suggests to assess astigmatism using astigmatic coefficient (K alpha), which is expressed as the cosine of the angle between the vertical and the direction of the stronger main meridian. Intra-and postoperative use of fibronectin solution is proposed to lower the K alpha and improve the efficacy of surgery.

Elastic polypropylene suture in cataract surgery: long-term follow-up

The final part of a prospective, controlled study of elastic polypropylene suture for cataract surgery was undertaken. The aim was to determine the change in induced astigmatism at 30 months after extracapsular cataract surgery and to assess the long-term safety of the suture material. Thirty-two of 44 patients were reexamined for changes in astigmatism. The results of all examinations were subjected to vector analysis. Both the elastic polypropylene group and the nylon control group continued to show an increase in the against-the-rule component of astigmatism. There was no statistical difference (p < 0.5) between the two groups at 30 months post-operatively, though the shift was greater in the polypropylene group. Wound security was similar for both groups but the polypropylene group had a higher incidence of giant papillary conjunctivitis (24%) due to exposed suture ends. The nylon suture was hydrolysed in 89% of that group and all patients were asymptomatic.

Implantation of AcrySof acrylic intraocular lenses

A surgical technique is described to facilitate safe implantation of acrylic posterior chamber intraocular lenses through the smallest incisions allowed by currently available implantation technology. The technique includes warming the lens before insertion, protecting the optic with viscoelastic before grasping it with insertion forceps, and using a Sinskey hook through the side port during lens rotation and unfolding.

The efficacy of a single continuous nylon suture for control of post keratoplasty astigmatism

PURPOSE

Post operative adjustment of a single continuous suture is an effective means of reducing post keratoplasty astigmatism. This study evaluates post keratoplasty keratometry following suture adjustment with an adjusted suture in place and after the suture is removed.

METHODS

Average keratometric astigmatism was measured over 24 months time in 26 patients with an adjusted continuous suture and 24 patients with a continuous suture that was not adjusted. Average keratometry in 43 patients with an adjusted continuous suture was compared with 37 patients with combined continuous and interrupted sutures. Finally, suture out astigmatism in 19 adjusted patients was compared to six patients with no adjustment.

RESULTS

There was an increase in average corneal astigmatism over two years of 2.2 diopters in the adjusted group and 1.7 diopters in the non-adjusted group with sutures in place. One year following surgery, average keratometry flattened from 47.5 to 42.9 diopters in the adjusted continuous group and from 47.0 to 46.0 diopters in the group with combined continuous and interrupted sutures. Following suture removal, average astigmatism in patients who had suture adjustment was 4.4 diopters +/- 2.5 diopters (range 1-10 diopters), and 6.01 diopters (range 4-7) in the non-adjusted group.

CONCLUSIONS

Average post keratoplasty astigmatism increases after a continuous suture is adjusted but the increase is comparable to patients with acceptable astigmatism who do not require adjustment. More progressive corneal flattening over 12 months time is seen with a continuous suture than which combined sutures. Average suture out astigmatism was 4.0 diopters following suture adjustment, compared to an average of 8.4 diopters prior to adjustment.

Implantation of a Staar silicone intraocular lens with the anterior chamber maintainer

A method for performing phacoemulsification and implantation of a foldable lens (Staar AA 4203) with an anterior chamber maintainer is described. The procedure eliminates the need for viscoelastics, preventing postoperative pressure elevation and reducing costs. The incision is kept sealed during the implantation with the injector, and the anterior chamber remains deep. Making a small incision under positive intraocular pressure pressure prevents the development of high astigmatism. I have implanted more than 500 lenses using this method, with very good results.

Post-operative astigmatism control by selective suture removal

Fifty eyes in 50 patients with > 2.5 dioptres (D) of with-the-rule astigmatism (refraction) following uncomplicated extracapsular cataract extraction were recruited for this prospective study. Selected single sutures were removed and both the amount of astigmatic loss and the change in axis were measured at intervals. After removal of the first suture the mean astigmatic loss at 1 week was 2.9 D by keratometry and the mean change in the axis was 23 degrees (74% occurred within the first hour). The astigmatic loss was greater with subsequent suture removal. Timing of suture removal (before or after 8 weeks) and the amount of initial post-operative astigmatism (more than or less than 5 D) had a minimal effect on the total astigmatic loss. We suggest selective single suture removal can be performed safely at 5-6 weeks post-operatively with removal of a second suture, if necessary, in the steepest axis after 1 hour. The prescription of spectacles should be delayed for 1 week after the final suture has been removed.

Evaluation of 6.5-mm BENT incision to reduce postoperative astigmatism

We examined surgically induced astigmatism following 6.5-mm incisions between 9 and 12 o'clock (BENT incision) in 50 cases with cataracts who underwent phacoemulsification-aspiration and 6-mm intraocular lens implantation. The surgically induced astigmatism (n = 50) shifted to against-the-rule astigmatism (ATR; -0.03 +/- 0.95 dpt) 1 day after the operation and then tended to shift to with-the-rule astigmatism (WTR). The results of a group with preexisting ATR (> 2 dpt; n = 4) were similar to the results of the aforementioned group, whereas the results of a group (n = 7) with preexisting WTR (> 2 dpt) were different. Astigmatism in this group shifted to ATR of about 1.0 dpt. This study suggests that the BENT incision procedure can reduce both preexisting WTR > 2.0 dpt and preexisting ATR > 2 dpt.

Long-term follow-up of a single continuous adjustable suture in penetrating keratoplasty

Penetrating keratoplasty was performed on 30 patients using a single adjustable continuous 10/0 nylon suture. Seventeen patients had astigmatism of 4.00 dioptre cylinders (DC) or more and were adjusted. The latest adjustment was at 32 weeks. Following adjustment there was a significant reduction in median post-keratoplasty astigmatism from 6.00 DC to 2.50 DC (p < 0.001). Thirteen patients, with astigmatism of 4.00 DC or less, were not adjusted. Median astigmatism for the non-adjusted group was 3.00 DC and for the entire group was 2.88 DC. Long-term refraction and suture status were monitored with time. Mean follow-up was 112 weeks (range 53-170 weeks). Over the study period the entire group showed significant 'long-term astigmatic drift' (LTAD), from 2.88 DC to 3.25 DC (median drift, 1.25 DC; range, 0.00-5.50 DC) (p < 0.001). Suture adjustment and suture removal showed no significant effect on LTAD. With suture removal between 32 and 84 weeks median LTAD was 1.50 DC. For suture removal after 84 weeks, median LTAD was also 1.50 DC, but the range of LTAD was 1.50 DC, compared with a larger range of 5.00 DC in the earlier suture removal group. The technique of single continuous adjustable sutures for penetrating keratoplasty is safe, effective in reducing astigmatism, but may need modification to further enhance long-term refractive stability.

Long-term course of induced astigmatism after clear corneal incision cataract surgery

PURPOSE

To determine whether a small clear corneal temporal incision produces less surgically induced astigmatism than a larger incision.

METHODS

One hundred three consecutive cases of postoperative astigmatism after clear corneal incision cataract surgery were studied for a minimum of 1 year. Only self-sealing incisions from the temporal side were made as follows: 3.2 mm (Group A); 4.0 mm (Group B); 5.2 mm (Group C). We considered the amount and axes of the keratometric readings at different times as well as their course over time. Induced astigmatism was calculated using three methods. Axial changes were also analyzed.

RESULTS

Immediately after the surgery, there was a small, surgically induced, with-the-rule astigmatic shift in all groups, which in most cases decreased to near preoperative levels with time. One year postoperatively. mean induced astigmatism was 0.09 diopter (D) in Group A, 0.26 D in Group B, and 0.54 D in Group C. Most cases had minimal axial changes. In Group A, 86% had an axial change of fewer than 30 degrees; in Group B, 76%; and Group C, 73%.

CONCLUSIONS

The smallest incision group had the least surgically induced astigmatism and axial change. All incision groups remained stable and had satisfactory clinical results.

[Reduction of induced corneal astigmatism after IOL implantation by small incision technique]

PURPOSE

To investigate the effect of incision length on corneal astigmatism after intraocular lens implantation.

METHODS

The change of induced corneal astigmatism was observed in 36 patients underwent phacoemusification cataract extraction with intraocular lens implantation through a 6.5 mm limbal incision comparing with that in extracapsular cataract extraction with intraocular lens implantation through a 11 mm limbal incision.

RESULTS

The surgically induced astigmatism in 1 week, 1.3 and 6 months after the operation was 2.13 +/- 1.41, 1.58 +/- 1.07, 0.92 +/- 0.75 and 0.77 +/- 0.55D in 6.5 mm limbal incision group while that was 4.63 +/- 1.39, 3.08 +/- 1.11, 2.52 +/- 0.89 and 2.04 +/- 0.87 in 11 mm incision group, the difference in the same postoperative period was significant (P < 0.05). At 1 week and 1 month postoperatively, 52.8% and 61.41% of 6.5 mm limbal incision cases had uncorrected visual acuity of 0.5 or better compared with 28.6% and 37.1% of 11 mm incision cases (P < 0.05). There was no difference of the uncorrected visual acuity 6 months after the surgery between the two groups.

CONCLUSION

Reducing incision can minimize surgically induced astigmatism and promote early postoperative visual rehabilitation.

Videokeratography: a comparison between 6 mm sutured and unsutured incisions for phacoemulsification

One of the main aims of small incisions in cataract surgery is to reduce surgically induced astigmatism to a minimum. A prospective study was set up to compare sutured with unsutured 6 mm scleral pocket frown incision wounds for phacoemulsification. Videokeratography was used to study the topographical changes induced by surgery. Two groups of 15 patients were allocated to have either sutured or unsutured 6 mm frown incisions for their phacoemulsification. Videokeratography was performed 1 day pre-operatively, and repeated 6 weeks post-operatively. Statistical analysis of the resultant data is discussed. The results show a modest flattening in the vertical meridian in both groups of patients which was slightly larger in the unsutured group. The astigmatic change did not differ significantly between the two groups. The 6 mm scleral pocket incisions induce a small amount of astigmatism whether sutured or unsutured. However, we felt it was perhaps safer to suture an incision of that size. Videokeratography is an invaluable tool for collection of outcome audit data, and allows for accurate graphical assessment of the effect of differing surgical approaches.

Effects of wound architecture and suture technique on postoperative astigmatism

BACKGROUND AND OBJECTIVE

A prospective randomized investigation was performed to evaluate the effects of wound architecture and suture techniques on postoperative astigmatism after phacoemulsification and intraocular lens implantation.

PATIENTS AND METHODS

Two hundred eyes with preexisting with-the-rule astigmatism were randomized into four groups: (1) sutureless scleral tunnel frown incision, (2) scleral tunnel frown incision with a horizontal suture, (3) scleral tunnel frown incision with both a horizontal and a running suture, and (4) posterior limbal acute beveled cataract incision with a running suture. All the incisions were placed in the vertical steep meridian.

RESULTS

Data were analyzed from 128 cases with 1-year follow-up. The results revealed that at the 2-month postoperative visit, preexisting astigmatism was significantly reduced in group 1 (P = .029) and significantly increased in groups 3 (P = .020) and 4 (P = .005). There was no significant change in group 2 (P = .06). By the 1-year postoperative visit, there was no significant difference in astigmatism from preoperative levels for all four groups. Vector analysis revealed no significant difference in the mean surgically induced cylinder at 1 year in all four groups. The number of eyes with induced against-the-rule astigmatism, however, was significantly higher than the number of eyes with induced with-the-rule astigmatism in all four groups (P <.01).

CONCLUSION

The authors found that sutured wounds placed in the vertical steep meridian may initially increase with-the-rule astigmatism, whereas nonsutured wounds placed in the vertical steep meridian may initially reduce with-the-rule astigmatism. By 1 year, however, a mean flattening of the vertical steep meridian was observed in the three groups with sutures as well as in the group without sutures.

Randomized clinical trial of penetrating keratoplasty. Before and after suture removal comparison of intraoperative and postoperative suture adjustment

PURPOSE

The authors performed a prospective, randomized clinical trial of penetrating keratoplasty and compared visual acuity, refraction, and topography up to 15 months postoperatively (3 months after suture removal) after intraoperative and postoperative suture adjustment.

METHODS

Twenty-five patients undergoing penetrating keratoplasty for avascular corneal pathology were randomly assigned to two groups. All surgery was done by one surgeon using the same technique (except for intraoperative suture adjustment) with suction trephination (8 mm) and a running 10-0 nylon suture. Intraoperative suture adjustment was performed in the test group and was not performed in the control group. Postoperative suture adjustment was done during the first postoperative month and up to 4 months postoperatively in all patients who had more than 3.5 diopters (D) of astigmatism. The running suture was removed at approximately 12 months postoperatively. Refraction and computed topographic analysis to compare patients with intraoperative and postoperative suture adjustment were performed at 1, 3, 6, 9, 12 (before suture removal), and 15 (after suture removal) months.

RESULTS

There was less (P = 0.004) topographic astigmatism up to 12 months postoperatively (pre-suture removal) in patients adjusted intraoperatively (mean +/- standard deviation, 1.53 +/- 0.72 D) than in patients adjusted postoperatively (2.83 +/- 1.19 D). After suture removal, at 15 months postoperatively, astigmatism was still less in the intraoperative adjustment group (1.75 +/- 1.04 D) than in the postoperative adjustment group (2.23 +/- 17.2 D), but the authors could not demonstrate statistical significance. After intraoperative adjustment, no significant change in mean astigmatism occurred, and no patient had more than a 1.18-D change in the amount of astigmatism or more than a 22 degrees change in axis (75% < 10 degrees change) after suture removal. Corneas were more regular until suture removal in the group with intraoperative adjustment, but differences decreased after suture removal. Best spectacle-corrected visual acuity was better in the intraoperatively adjusted group until suture removal with no significant changes in best spectacle-corrected visual acuity between 1 and 15 months. Best spectacle-corrected visual acuity improved more slowly after postoperative adjustment and was different at 1 and 15 months (P = 0.0005).

CONCLUSION

The authors demonstrated low astigmatism and good visual results at 15 months postoperatively after either intraoperative or postoperative running suture adjustment, but intraoperative suture adjustment permitted more rapid visual rehabilitation, increased safety, and increased refractive stability.

Modified scleral flap incision to reduce corneal astigmatism after intraocular lens implantation

PURPOSE

To investigate a simple method during extracapsular cataract extraction with posterior chamber intraocular lens implantation in order to reduce surgically induced corneal astigmatism.

METHODS

A modified scleral flap incision was used in the extracapsular cataract extraction with intraocular lens implantation and the postoperative changes in corneal astigmatism was observed.

RESULTS

The peak value of postoperative corneal astigmatism was 3.60 D, and the corneal astigmatism regression was 2.11 D, surgically induced astigmatism was less significant in modified scleral flap incision group than that in conventional limbal incision group (P < 0.05).

CONCLUSIONS

The modified scleral flap incision is an ideal incision for cataract extraction with intraocular lens implantation when phacoemulsifier is not available.

Storage, surgery outcome, and complications of corneal and conjunctival grafts

Recent articles related to corneal storage, surgery outcome, and complications of corneal and conjunctival grafts are reviewed. It appears that the addition of insulin and human epidermal growth factor may benefit storage solutions. Several multivariant analyses of risks for graft rejections are included, and include corneal vascularization, failed previous grafts, and preoperative endothelial damage. Transverse keratotomy as a method of controlling astigmatism after grafting may be effective. The incidence of acute hydrops in patients with keratoconus is about 2.8%. Free conjunctival grafts are reported to be useful in repairing failed filtering blebs and persistent bleb leaks.

[Modification of the no-stitch technique in extracapsular cataract extraction by a single radial suture. Effect on postoperative astigmatism]

Self-sealing intrascleral wound construction with a trapezoidal 12-mm incision for extracapsular cataract extraction and implantation of a standard PMMA IOL with a 6.5-mm optical diameter using the no-stitch technique has been well established at our clinic since 1991. This technique allows cataract surgery in a nearly closed system. In consideration of our earlier results, the no-stitch technique was modified by a single perpendicular suture in the middle of the 12-mm incision to reduce postoperative induced astigmatism further. We examined 200 consecutive patients 6 months after surgery (no-stitch vs one-stitch wound closure). The preoperative average astigmatism was 0.86 +/- 0.68 D (1.01 +/- 0.95 D). Preoperatively 37% (47%) of the eyes had With the Rule Astigmatism and 47% (39%) Against the Rule Astigmatism. Six months after surgery 10% (8%) of the cases showed With the Rule Astigmatism and 72% (65%) Against the Rule Astigmatism. Induced astigmatism was stabilized to 1.43 +/- 0.87 D (2.11 +/- 1.43 D). Compared with sutureless wound closure, the one-stitch technique had no long-term effect on the axes of astigmatism but significantly diminished induced astigmatism about 0.5 D.

[Etiology of insufficient wound sealing in cataract operation with the no-stitch technique]

BACKGROUND

The no-stitch technique has become a standard procedure in cataract surgery in a short time. Nevertheless, it could be necessary--especially when learning this technique--to use a suture to close the wound.

PATIENTS

In this study we examined 24 patients who needed a suture from April 1991 to July 1993. By using a gonioscope we tried to find the reason for the insufficient self-sealing effect. During this period there were 7,966 cataract operations using the no-stitch tunnel technique, including about 618 eyes with a self-sealing ECCE technique.

RESULTS

In 13 eyes iris prolapse was found, in 9 eyes low IOP and in 2 eyes exceptionally astigmatism. In 11 eyes the reasons for these complications were that the inner corneal lamella was too small, in 9 eyes this lamella was cut, and in 2 eyes there was a step between this lamella and the inner surface of the cornea. The reason for the high astigmatism in 2 cases was not found in the corneal lamella, but in the scleral one which had shown a defect. The incidence of insufficient wound closure was 0.81% in ECCE (n = 618) and 0.26% in phacoemulsification surgery (n = 7348).

CONCLUSION

The most common reason for insufficient wound closure in the no-stitch technique is malpreparation of the corneal lamella.