J Korean Ophthalmol Soc.  2014 Oct;55(10):1470-1475. 10.3341/jkos.2014.55.10.1470.

The Comparison of Astigmatic Outcomes after Cataract Surgery of Inferior versus Superior Clear Corneal Incision

• Na JK
• Kim MS

• KMID: 2216864
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1470

Abstract

PURPOSE
To analyze the difference in astigmatism and the mean change in total astigmatism between inferior clear corneal incision and superior clear corneal incision following cataract surgery in surgically-induced astigmatism (SIA).
METHODS
Fifty-five eyes of 55 patients with with-the-rule astigmatism >0.5 diopters were evaluated. Patients were divided into two groups according to incision location (Group 1, 26 eyes with an inferior incision; Group 2, 29 eyes with a superior incision). Patients were evaluatied one month postoperatively. Uncorrected visual acuity (UCVA, log MAR), best-corrected visual acuity (BCVA, log MAR), SIA and mean change in corneal astigmatism were measured in both groups.
RESULTS
One month postoperatively, mean UCVA was 0.15 +/- 0.17 log MAR in Group 1 and 0.23 +/- 0.24 log MAR in Group 2 (p = 0.253). Mean BCVA was 0.08 +/- 0.13 and 0.08 +/- 0.12 log MAR in Groups 1 and 2, respectively (p = 0.926). The SIA was 0.50 +/- 0.17 diopter and 0.57 +/- 0.34 diopter (p = 0.253) and mean change in total astigmatism was 0.50 +/- 0.96 diopter and 0.38 +/- 0.86 diopter in Groups 1 and 2, respectively (p = 0.426).
CONCLUSIONS
There was no statistically significant difference between the two groups. Thus, corneal incision on the inferior side in patients of with-the-rule astigmatism can reduce the SIA and mean change in corneal astigmatism for patients with glaucoma, hard upper eyelid tension or sunken eye.

Keyword

Cataract surgery; Corneal astigmatism; Inferior clear corneal incision; Superior clear corneal incision; Surgically-induced astigmatism

MeSH Terms

Astigmatism
Cataract*
Eyelids
Glaucoma
Humans
Visual Acuity

Figure

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  Figure 1. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) in the 2 groups.

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  Figure 2. Surgically induced astigmatism (SIA) and change in cylinder (absolute value of preoperative cylinder - absolute value of postoperative cylinder) doesn't show statistically significant difference between 2 groups.

Reference

References

1. Tejedor J, Murube J. Choosing the location of corneal incision based on preexisting astigmatism in phacoemulsification. Am J Ophthalmol. 2005; 139:767–76.

2. Khokhar S, Lohiya P, Murugiesan V, Panda A. Corneal astigmatism correction with opposite clear corneal incisions or single clear corneal incision: comparative analysis. J Cataract Refract Surg. 2006; 32:1432–7.

3. Bayramlar H, Hü Dağlioğlu MC, Borazan M. Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery. J Cataract Refract Surg. 2003; 29:723–8.

4. Barequet IS, Yu E, Vitale S, et al. Astigmatism outcomes of horizontal temporal versus nasal clear corneal incision cataract surgery. J Cataract Refract Surg. 2004; 30:418–23.

5. Kaufmann C, Peter J, Ooi K, et al. Limbal relaxing incisions versus on-axis incisions to reduce corneal astigmatism at the time of cataract surgery. J Cataract Refract Surg. 2005; 31:2261–5.

6. Wang Li, Misra M, Koch DD. Peripheral corneal relaxing incisions combined with cataract surgery. J Cataract Refract Surg. 2003; 29:712–22.

7. Seo JB, Joo CK. Long-term course of induced astigmatism after temporal clear corneal incision in cataract surgery. J Korean Ophthalmol Soc. 1999; 40:3038–43.

8. Shepherd JR. Induced astigmatism in small incision cataract surgery. J Cataract Refract Surg. 1989; 15:85–8.

9. Cravy TV. Routine use of a lateral approach to cataract extraction to achieve rapid and sustained stabilization of postoperative astigmatism. J Cataract Refract Surg. 1991; 17:415–23.

10. Vasavada A, Singh R. Relationship between lens and capsular bag size. J Cataract Refract Surg. 1998; 24:547–51.

11. Axt JC, McCaffery JM. Reduction of postoperative against-the-rule astigmatism by lateral incision technique. J Cataract Refract Surg. 1993; 19:380–6.

12. Brint SF. Refractive cataract surgery. Int Ophthalmol Clin. 1994; 34:1–11.

13. Koch PS. Mastering phacoemulsification: A simplified manual of strategies for the spring, crack, and stop & chop technique. 4th ed.Thorofare, NJ: Slack;1994; 7–44.

14. Lindstrom RL. Cataract surgery and lens implantation. Curr Opin Ophthalmol. 1994; 5:1–4.

15. Axt JC, McCaffery JM. Reduction of postoperative against-the-rule astigmatism by lateral incision technique. J Cataract Refract Surg. 1993; 19:380–6.

16. Mendívil A. Comparative study of astigmatism through superior and lateral small incisions. Eur J Ophthalmol. 1996; 6:389–92.

17. Roman S, Ullern M. [Astigmatism caused by superior and temporal corneal incisions in cataract surgery]. J Fr Ophtalmol. 1997; 20:277–83.

18. Joo CK, Han HK, Kim JH. Computer-assisted videokeratography to measure changes in astigmatism induced by sutureless cataract surgery. J Cataract Refract Surg. 1997; 23:555–61.

19. Simşek S, Yaşar T, Demirok A, et al. Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoe-mulsification. J Cataract Refract Surg. 1998; 24:515–8.

20. Roman SJ, Auclin FX, Chong-Sit DA, Ullern MM. Surgically induced astigmatism with superior and temporal incisions in cases of with-the-rule preoperative astigmatism. J Cataract Refract Surg. 1998; 24:1636–41.