Scleral incisions have a lot of importance in regards to the surgical procedure adopted and the type of incision that is framed. Linear, frown and smile are the most common types of scleral incisions. Some surgeons who perform phacoemulsification and IOL implantation have also employed J incisions, inverse J incisions and L-shaped scleral incisions. L-shaped incisions have been reported to be an astigmatically neutral incision that even allows a non-foldable IOL to be either inserted or explanted.
This video demonstrates the application of an L-shaped incision for explantation of a decentered IOL followed by implantation of a three-piece IOL for glued IOL surgery. After conjunctival peritomy, a 3-mm mark is set on a vernier caliper and the L-shaped incision is marked. A scleral crescent blade is then utilized to create an incision. Infusion is introduced in the eye, and iris hooks are employed because the pupil size is quite small. The decentered IOL is explanted along with the expulsion of the Soemmering ring from the L-shaped incision. Vitrectomy is performed, and glued IOL surgery is then done.