L-shaped scleral incision may be ideal for IOL explantation, insertion

In intraocular surgery, the placement of an incision has a lot of significance pertaining to the amount of surgically induced astigmatism and the wound architecture. Taking into consideration the anatomical location, among the various types of incisions, scleral incisions have played a significant role in phacoemulsification and in small-incision cataract surgery. A “J-shaped” incision, an “inverse J-shaped” incision and an “L-shaped” incision have been described previously by surgeons in both peer- and non-peer-reviewed literature, and they have been employed for performing phacoemulsification and also for introducing an IOL.The length and width of the incision, the relationship between the length and width of the incision, and the distance of the scleral incision from the limbus significantly affect postoperative astigmatism. A square incision wherein the length and width of the incision are equal is the most astigmatically stable wound, and an L-shaped incision has been considered to be superior to the conventional linear incision due to its astigmatically neutral wound architecture. The scar tissue tends to contract as much along its horizontal axis as its perpendicular axis. This principle probably helps to settle the issue of irregular scarring in a scleral incision, leading to an astigmatically neutral wound.