Square is good when it comes to corneal incisions

ByUday Devgan, MD

The clear corneal incision's dimensions are outlined to highlight the square shape.

I had just finished teaching cataract surgery to one of the UCLA ophthalmology residents who had a lot of difficulty with creating the clear corneal incision. The key point that she was missing was that the incision should be relatively square, with the tunnel length of the incision about equal to the incision width.

The square incision creates a better-sealing incision and will induce less astigmatism. Making a consistent square incision is paramount to becoming a refractive cataract surgeon. This may also be helpful in preventing endophthalmitis, which is far more

common if the incision is less than perfectly sealed. With premium lenses, such as accommodating IOLs, making the eye absolutely water-tight at the end of the surgery is critical to maintaining the proper effective lens position in the eye. Any flattening of the anterior chamber can cause an anterior displacement of the IOL and an induced myopia with loss of accommodative amplitude.

I asked the resident to make one simple New Year's resolution for the operating room: Learn how to make a square clear corneal incision.