For 99% of my patients, making a corneo-limbal phaco incision is ideal. However, there are cases such as this patient with many prior radial keratotomy cuts, where we must avoid any type of corneal incision. In this case, we need to make a scleral tunnel incision.
As the name implies, this incision is a tunnel within the sclera and it allows good access to the anterior segment while avoiding touching the cornea. Note that this incision is more distal and more posterior than a typical corneal phaco incision and that may require adjusting the angle of surgical instruments during the procedure.
This video shows the creation of the incision as well as suture closure at the end of the surgery. This video is a must-see for doctors in training — make sure you master this technique!
click below to learn how to make (and suture) a scleral tunnel incision: