DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151448

Comparison of surgically induced astigmatism in corneo-scleral and clear corneal incision in phacoemulsification

Latha N.V, Risha Ravindran, Asha A.V, Twinkle Ann George

Abstract


Background: The objective of the study was to determine and compare the surgically induced astigmatism in patients who have undergone phacoemulsification with clear corneal and corneoscleral incisions made superiorly and temporally.

Methods: Study was conducted in 100 patients who underwent cataract surgery from a period of November 2012 to July 2014. They were evaluated pre and post-operatively. Pre-op and Post-op Vision, retinoscopy and keratometry were analysed and surgically induced astigmatism was calculated using Vector method.

Results: Surgically induced astigmatism calculated with SIA Calculator using Holladay’s method was as follows; Superior corneoscleral 0.79 D,  Temporal corneoscleral  0.52 D, Superior clear corneal 0.60 D, Temporal clear corneal 0.73 D. A higher incidence of against the rule astigmatism was seen pre-operatively (45%) and post-operatively (42%).

Conclusions: From our study, we have concluded that no significant difference was seen in the surgically induced astigmatism following phacoemulsification in all four incisions though the least SIA value was obtained with Temporal corneo-scleral. To conclude, temporal corneo-scleral incisions being farther away from the visual axis has minimal effect on the corneal curvature with near astigmatic neutrality. 

 


Keywords


Surgically induced astigmatism, Clear corneal incision, Corneo-scleral incision, Keratometry

Full Text:

PDF

References


Duke-Elder S, Abrams D. Ophthalmic optics and refraction. In: Duke-Elder’s System of Ophthalmology. Vol V, 1st edition. St Loius: Mosby. 1970:27-295.

Jaffe NS, Jaffe MS, Jaffe GF. Intraocular lens implants. In: Jaffe’s cataract surgery and its complications; 6th edition. Harcourt, Mosby. 1997:147-199.

Khurana AK, Indu Khurana. Cornea, limbus and sclera.In: Anatomy and physiology of Eye. 2nd edition.Cbs. 2011:21-41.

Troutman RC, Buzard KA. Detection and measurement of astigmatism: Instruments and techniques. In Troutman’s Corneal Astigmatism. Mosby- Year book Inc. 1992:92-117.

Koch P. Structural analysis of cataract incision construction. J Cataract Refract Surg. 1991;17:661-7.

Pallin S. Comparison of induced astigmatism with phacoemulsification and extracapsular cataract extraction. J Cataract Refract Surg. 1991;13:274-8.

Gills J, Sanders D. Use of small incisions to control induced astigmatism and inflammation following cataract surgery. J Cataract Refract Surg. 1991;17:740-4.

Hall G.W., Campion M., Sorenson C., Monthofer S. Reduction of corneal astigmatism at cataract surgery. J Cataract Refract Surg. 1991;17:407-14.

Freeman J. Scleral stretch incision for cataract surgery: a technique for no suture closure and control of astigmatism. J Cataract Refract Surg. 1991;17:696-701.

Pallin S. Chevron sutureless closure: a preliminary report. J Cataract Refract Surg. 1991;17:706-9.

Burgansky Z, Isakov I, Avizemer H, Bartov E. Minimal astigmatism after sutureless planned ECCE. J Cataract Refract Surg. 2002;28:499-503.

Masket S. Astigmatic analysis of the scleral pocket incision and closure technique for cataract surgery. CLAO Journal. 1985;11:3:206-9.

Steinert RF, Brint SF, White SM, Fine IH. Astigmatism after small incision cataract surgery. A prospective, randomized, multicenter comparison of 4-and 6.5- mm incisions. Ophthalmology. 1991;98:417-23.

Oshika T., Tsuboi, Yaguchi S., et al. Comparative study of intraocular lens implantation through 3.2 -and 5.5-mm incisions. Ophthalmology. 1994;101:1183-90.

Lyhne N, Hansen TE, Corydon L. Relation between preoperative axis of astigmatism and postoperative astigmatic changes after superior scleral incision. J Cataract Refract Surg. 1998;24:935-9.

Anders N, Pham DT, Antoni Hj, Wollensak J. Postoperative astigmatism and relative strength of tunnel incisions: a prospective clinical trial. J Cataract Refract Surgery. 1997;23:332-6.

Kohnen T, Mann PM, Husain SE. Corneal topographic changes and induced astigmatism resulting from superior and temporal scleral pocket incisions.Ophthalmic Surg Lasers. 1996;27:263-9.

Kohnen T. Corneal shape changes and astigmatic aspects of scleral and corneal tunnel incisions. J Cataract Refract Surg. 1997;23:301-2.

Gokhale N.S., Sawhney S. Reduction in astigmatism in manual small incision cataract surgery through change of incision site. Indian J Ophthalmol. 2005;53:201-3.

Oshika T, Sugita G, Tanabe T, Tomidokoro A, Amano S. Regular and irregular astigmatism after superior versus temporal scleral incision cataract surgery. Ophthalmology 2000;107:2049-53.

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

Kelman CD. Phacoemulsification and aspiration: a new technique of cataract removal. A preliminary report. Am J Ophthalmol. 1967;64:23-35.

Rainer G., Menapace R., Vass C. Corneal shape changes after temporal and superolateral 3mm clear corneal incisions. J Cataract Refract Surg. 1999;25:1121-6.

Imek, Yaar T, Demirok A. Effect of superior and temporal clear corneal incisions on astigmatism after phacoemulsification. J Cataract Refract Surg. 1998;24:515-8.

Lyhne N, Krogsager J, Corydon L, Kjeldgaard M. One year follow-up of astigmatism after 4.0 mm temporal clear corneal and superior scleral incisions. J Cataract Refract Surg. 2000;26:83-7.

Pakravan M., Nikkhah H.,Yazdani S., Shahabi C., Sedigh-Rahimabadi M. Astigmatic Outcomes of Temporal versus Nasal Clear Corneal Phacoemulsification. J Ophthalmic Vis Res. 2009;4:79-83.

Altan-Yaycioglu R., Akova, Y.A., Akca S., Gur S. Effect on Astigmatism of the Location of Clear Corneal Incision in Phacoemulsification of Cataract. J Refract Surg. 2007; 23:515-8.

Barequet IS, Yu E, Vitale S, Cassard S, Azar DT, Stark WJ. Astigmatism outcomes of horizontal temporal versus nasal clear corneal incision cataract surgery. J Cataract Refract Surg. 2004;30:418-23.

Susie N, Brajkovie J, Kalauz-Surae I. Analysis of post operative corneal astigmatism after phacoemulification through a clear corneal incision. Aera Clin Croat. 2007;46:37-40

Mirzaie M. Keratometric alteration in sutureless phacoemulsification cataract surgery with clear corneal and scleral incisions.

Poort-van Nouhuijs HM, Hendricks KH, van Marle WFf, Boesten I, Beekhuis WH. Corneal astigmatism after clear corneal and corneoscleral incisions for cataract surgery. J Cataract Refract Surg. 1997;23:758-60.

Pallin SL. Self-sealing incision. In: Agarwal S, Bonnett R, Agarwal A, editors. Phacoemulsifi cation. London: Taylor and Francis. 2004;199-204.

Noel A. Alpins, Michael Goggin, PracticalAstigmatism Analysis for Refractive Outcomes in Cataract and Refractive Surgery. Survey of Ophthalmology. 2004;49(1):109-21.

Tetsuro Oshika, Gentaro Sugita,Tatsuro Tanabe. Regular and Irregular Astigmatism after Superior versus Temporal Scleral Incision Cataract Surgery. Ophthalmology. 2000;107:2049–53.

Yoon JH, Kim K, Lee JY, Nam DH. Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery.Indian J Ophthalmol. 2013;61:645-8.

Sedaghat M.R., Gharaei Hamid, Yaghoubi N. A dynamic study on the surgically induced astigmatism after phacoemulsification through different incisions. Iranian Journal of Ophthalmology 2003;16(1):14-23.

Bilińska E, Wesołek-Czernik A, Synder A, Omulecki W. Surgically induced astigmatism after cataract phacoemulsification. Klin Oczna. 2004;106(6):756-9.

Sujithra H, M Dhar, Dhireesh, Robin Shanmugham.Assessment of Merits of Clear Corneal Incision over Scleral Tunnel Incision in Phacoemulsification. Kerala Journal of Ophthalmology. 2008;XX(3):259-62.