Posterior limbal incision

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Abstract
Background: Sutureless cataract incisions should ideally remain sealed with increased intraocular pressure and be able to withstand increased external pressure to the posterior aspect. Cadaver eye studies have shown that meeting these criteria requires an internal corneal lip of at least 1.5 mm and a square wound. Scleral incisions can meet these criteria but sacrifice aesthetics and surgical efficiency. Clear corneal incisions provide aesthetics and surgical efficiency but not wound stability. An ideal incision would combine stability with aesthetics and efficiency. Methods: We tested a posterior limbal incision to assess its stability, aesthetics, and efficiency. The incision originated at the posterior limbus within the conjunctiva, gaining about 1.0 mm in tunnel length over a clear corneal incision. This was enough to obtain a square profile for 3.0 × 3.0 mm wide incisions, while providing the aesthetics and surgical efficiency of a clear corneal incision. We compared a 3.0 × 2.0 mm posterior limbal with a 3.0 × 2.0 mm clear corneal incision. Each was tested in stepped, paracentesis, and hinged profiles. Results: The hinged incision performed better than the stepped incision, which was superior to the paracentesis incision. In all cases, the limbal incision performed better than the corneal incision, even when both incisions were equally rectangular. Conclusions: When compared with the clear corneal incision, the posterior limbal incision is equal in aesthetics and surgical efficiency, slightly superior in patient comfort, and far more stable.

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