ABSTRACT
Prior to the advent of silk sutures, sutureless cataract incisions were the norm of necessity in ophthalmology but they were not self-sealing for obvious reasons relating to technique and instrumentation. Many advances in technique and technology have taken us through several stages in the evolution of modern cataract operations. The earliest mentions of self-sealing cataract incisions were made by Richard P Kratz in 19801 and by Louis J Girard in 1984.2,3 Dr Kratz viewed the scleral tunnel incision as an astigmatism-neutral method of entering the anterior segment and felt that the sutures which he routinely used provided a “belt and suspenders” secure closure. In 1980s, a mention was made by Jim Gills at a meeting in Atlanta, Georgia, USA, that a sutureless cataract closure should be possible. In March, 1990, Steven B Siepser described a radial transverse incision which admitted only foldable implants.4 This was a workable but technically difficult incision, and was potentially dangerous in inexperienced hands. A brief published report in Ocular Surgery News in March, 1990 quoted Michael McFarland5 who indicated he had developed a sutureless incision for foldable implants which was based on a series of relaxing incisions in
the bed of a scleral tunnel. In April, 1990 a Chevron-shaped sutureless scleral tunnel incision (Fig. 16.1) was described by the author in a letter to the Editor of the Journal of Cataract and Refractive Surgery.6 The Chevron® incision was designed to admit not only foldable but rigid lenses as well, and was practical and easily adopted by cataract surgeons. Preliminary results with the Chevron® incision7 were presented at the 1991 American Society of Cataract and Refractive Surgeons (ASCRS) meeting in Boston, Massachusetts. A similar incision called the Frown incision was widely popularized by Jack Singer. Dr. Singer initially closed with one suture and later adapted the Frown incision to sutureless cataract surgery.8
