Cataract Surgery Creating a Watertight Incision

MAY 2010 CATARACT & REFRACTIVE SURGERY TODAY 35 David R. Hardten, MD For lens implantation, especially with the newest presbyopia-correcting IOLs, all aspects of the cataract surgical procedure should be of the highest quality to achieve the goal of rapid visual recovery. Safety must also be a high priority, as surgeons try to perfect all of the procedure’s steps to meet patients’ ever-rising expectations. A crucial component of success is a wound that seals well. It is at times difficult to create an incision that is astigmatically neutral, self-sealing, and comfortable. I have found that both diamond and metal blades are acceptable for creating incisions that are typically selfsealing and watertight. The newer metal blades are quite sharp, have trapezoid edges, and provide an economical way to make an incision. When keratomes are taken care of by a conscientious staff, I prefer diamond blades, as I believe the incisions I create with them are more reproducible. In a hospital setting or in a multispecialty ambulatory surgery center, however, the breakage and damage rate is such that I use metal blades.