Overlay the keratome to plan out the incision

In all surgeries, you must make the effort to create a great incision, which I have previously described as part of your unique signature that you leave on every eye. The incision will affect the fluidics and maneuverability during surgery and will induce an astigmatic effect.

In some cases, the incision placement and creation are even more important because a poorly constructed incision can have further complications. A case like this is radial keratotomy (RK), an antiquated technique of kerato-refractive surgery which was done primarily in the 1980s and was then phased out in the late 1990s as the excimer laser for PRK and LASIK came to market.

This example shows a patient with 8 radial cuts where extend from the limbus to the central cornea. Each of these cuts is 90% depth or more and we must avoid intersecting these cuts with our phaco incision. If we intersect these cuts, there is a good chance that they will rip open even more and cause fluidic instability during surgery. This could lead to a ruptured posterior capsule and it will likely require multiple sutures to close the cornea at the end of the case.

We can place our keratome on top of the cornea and visualize the desired path and placement of the phaco incision before actually making it. In our example here, it is clear that the phaco incision can fit nicely between these two RK cuts without intersecting them.

Click below to see how we plan out the phaco incision by overlaying the keratome:

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