Eyeworld

WINTER 2025 | EYEWORLD | 41 C Dr. Hoffman noted that a single-plane inci- sion is made with a diamond or metal keratome, starting just in front of the conjunctival insertion with the blade entering the anterior chamber with an upward direction parallel to the plane of the peripheral cornea. The incision should have a similar length as the width to create a near square configuration, he said. Placing the incision in the depths of a 350- to 400-micron deep temporal grooved inci- sion can help reduce small amounts of against- the-rule astigmatism that are too small for toric IOL placement, especially when paired with a second limbal relaxing incision 180 degrees away from the main incision. Dr. Hoffman added that a scleral incision usually requires a conjunctival peritomy with or without the concomitant use of scleral cauteri- zation. "A groove is usually created for the start of the scleral incision followed by dissection into clear cornea utilizing a diamond or metal crescent blade," he said. "An alternative is a straight planar entry into the anterior chamber starting 1 mm posterior to the limbus and enter- ing the anterior chamber at least 2 mm from the limbus. It is important to ensure that the entry site of scleral incisions into the anterior cham- ber is adequately anterior in order to avoid iris prolapse." Dr. Hoffman noted that scleral incisions are mainly utilized in patients with multiple radial keratotomy (RK) incisions. "Most in- dividuals who have a conservative, eight-cut RK can still be approached with clear corneal incisions placed between the radial incisions," he said, adding that when there are too many RK incisions to safely fit the cataract incision between the radial incisions, a scleral incision is necessary in order to prevent dehiscence of the RK incisions. "I personally utilize 1.1 mm bimanual incisions for my cataract surgery, placing the chopping infusion cannula through one incision and the bare phaco needle through the second incision," he said. "With this configuration, the 1.1 mm clear corneal incisions can usually fit between a 24-cut RK." He added that when it's time to insert the IOL, a 2.2 mm scleral incision continued on page 42 Anterior segment OCT of supraincisional Wong pocket (at leading edge of red arrow) Hydration of Wong pocket with balanced salt solution Anterior segment OCT showing hydrated Wong pocket pushing down and sealing phaco incision Source (all): Sumit "Sam" Garg, MD

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