Sutureless one-handed intercapsular phacoemulsification. The keyhole technique.

Advances in the phacoemulsification technique have made small incision cataract surgery with lens implantation and sutureless incision closure a reality. This paper describes a step-by-step technique of small incision construction (the key), capsulorhexis (the keyhole), hydrodissection, intercapsular phacoemulsification (the doorway), and small incision lens implantation without the need for suture closure. A review of 200 cases with follow-up at one year is described. Evaluation of a postmortem eye at eight weeks following this sutureless technique indicates that these incisions are self-sealing, do not leak, do not induce astigmatic change, and allow rapid visual recovery.