Surgically Induced Corneal Astigmatism Following Cataract Surgery

Derya Buran Kağnici¹, Tolga Kocatürk^2*, Harun Çakmak², Sema Oruç Dündar²

¹Department of Ophthalmology, Aydin State Hospital, Aydin, Turkey.
²Department of Ophthalmology, Adnan Menderes University Medical Faculty, Aydin, Turkey.

DOI: 10.4236/ojoph.2015.52008                

Abstract

Aim: To study the surgically induced astigmatism (SIA) caused by two different type main incisions in phacoemulsification. Methods: Sixty-eight eyes of 65 patients who underwent phacoemul-sification were randomly divided into two groups according to main incision type: 2.8 mm superior limbal incision (in Group 1) and 2.8 mm upper clear corneal incision (in Group 2). Surgical techniques did not differ between the groups except for the main incisions. All patients received detailed ophthalmological examination in addition to keratometry at the pre- and post-operatively. The preoperative and postoperative astigmatisms were calculated by the vector analysis method and the SIA was compared between the groups. Results: The mean SIA values were 1.3 ± 0.67 D, 0.89 ± 0.47 D, 0.77 ± 37 D in Group 1 and 1.42 ± 0.62 D, 1.15 ± 0.54 D, 0.94 ± 0.47 D in Group 2 on the first day, first week and first month postoperatively, respectively. According to the vector analysis, SIA was less in Group 1 than Group 2; although the difference was not statistically significant (p > 0.05). Conclusion: Although less astigmatism was detected in the superior limbal incision group, this difference was not statistically significant.

Keywords

Cataract, Phacoemulsification, Surgically Induced Astigmatism

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Jackson, T.L. (2008) Moorfields Manual of Ophthalmology. Mosby Elsevier, Philadelphia, 6.
[2]	Henderson, B., Pineda, R., Ament, C., Chen, S. and Kim, J. (2007) Essentials of Cataract Surgery. Slack Incorporated, Online Library, Chapter 2.
[3]	Albert, D.M., Miller, J.W., Azar, D.T. and Blodi, B.A. (2008) Principles and Practice of Ophthalmology. 3rd Edition, Saunders Company, Philadelphia, Chapter 120.
[4]	Henderson, B., Pineda, R., Ament, C., Chen, S. and Kim, J. (2007) Essentials of Cataract Surgery. Slack Incorporated, Online Library, Chapter 7.
[5]	Kohnen, T. (1997) Corneal Shape Changes and Astigmatic Aspects of Scleral and Corneal Tunnel Incisions. Journal of Cataract Refractive Surgery, 23, 301-302. http://dx.doi.org/10.1016/S0886-3350(97)80168-X
[6]	Henderson, B., Pineda, R., Ament, C., Chen, S. and Kim, J. (2007) Essentials of cataract surgery. Slack Incorporated, R2 Online Library, Chapter 6.
[7]	Kohnen, S., Neuber, R. and Kohnen, T. (2002) Effect of Temporal and Nasal Unsutured Limbal Tunnel Incisions on Induced Astigmatism after Phacoemusification. Journal of Cataract Refractive Surgery, 28, 821-825. http://dx.doi.org/10.1016/S0886-3350(01)01215-9
[8]	Wirbelauer, C., Anders, N., Pham, D.T. and Wollensak, J. (1997) Effect of Incision Location on Preoperative Oblique Astigmatism after Scleral Tunnel Incision. Journal of Cataract Refractive Surgery, 23, 365-371. http://dx.doi.org/10.1016/S0886-3350(97)80181-2
[9]	Simsek, S., Yasar, T., Demirok, A., Cinal, A. and Yilmaz, O.F. (1998) Effect of Superior and Temporal Clear Corneal Incisions on Astigmatism after Sutureless Phacoemulsification. Journal of Cataract Refractive Surgery, 24, 515-518. http://dx.doi.org/10.1016/S0886-3350(98)80294-0
[10]	Pakravan, M., Nikkhah, H., Yazdani, S., Shahabi, C. and Rahimabadi, M.S.M. (2009) Astigmatic Outcomes of Temporal versus Nasal Clear Corneal Phacoemulsification. Journal of Ophthalmic Vision Research, 4, 79-83.
[11]	Ozkurt, Y., Erdogan, G., Guveli, A.K., et al. (2008) Astigmatism after Superonasal and Superotemporal Clear Corneal Incisions in Phacoemulsification. International Ophthalmology, 28, 329-332. http://dx.doi.org/10.1007/s10792-007-9141-y
[12]	Long, D.A. and Monica, M.L. (1996) A Prospective Evaluation of Corneal Curvature Changes with 3.0 to 3.5 mm Corneal Tunnel Phacoemulsification. Ophthalmology, 103, 226-232. http://dx.doi.org/10.1016/S0161-6420(96)30712-4
[13]	Kilic, A., Gul, A., Yener, H.I., Cinal, A. and Demirok, A. (2010) Surgically Induced Astigmatism after Superotemporal or Superonasal Clear Corneal Incision in Phacoemulsification Surgery. Van Medical Journal, 17, 84-88.
[14]	Yaycioglu, A., Akova, Y.A., Akca, S., Gur, S. and Oktem, C. (2007) Effect on Astigmatism of the Location of Clear Corneal Incision in Phacoemulsification of Cataract. Journal of Refractive Surgery, 23, 515-518.
[15]	Rainer, G., Menapace, R., Vass, C., Annen, D., Findl, O. and Schmetterer, K. (1999) Corneal Shape Changes after Temporal and Superolateral 3,0 mm Clear Corneal Incisions. Journal of Cataract Refractive Surgery, 25, 1121-1126. http://dx.doi.org/10.1016/S0886-3350(99)00132-7
[16]	Ermis, S.S., Inan, U.U. and Ozturk, F. (2004) Surgically Induced Astigmatism after Superotemporal and Superonasal Clear Corneal Incisions in Phacoemulsification. Journal of Cataract Refractive Surgery, 30, 1316-1319. http://dx.doi.org/10.1016/j.jcrs.2003.11.034
[17]	Tejedor, J. and Murube, J. (2005) Choosing the Location of Corneal Incision Based on Preexisting Astigmatism in Phacoemulsification. American Journal of Ophthalmology, 139, 767-776. http://dx.doi.org/10.1016/j.ajo.2004.12.057
[18]	Kohnen, T., Dick, B. and Jacobi, K.W. (1995) Comparison of the Induced Astigmatism after Temporal Clear Corneal Tunnel Incisions of Different Sizes. Journal of Cataract Refractive Surgery, 21, 417-424. http://dx.doi.org/10.1016/S0886-3350(13)80532-9
[19]	Huang, F.C. and Tseng, S.H. (1998) Comparison of Surgically Induced Astigmatism after Sutureless Temporal Clear Corneal and Scleral Frown Incisions. Journal of Cataract Refractive Surgery, 24, 477-481. http://dx.doi.org/10.1016/S0886-3350(98)80287-3
[20]	He, Y., Zhu, S., Chen, M. and Li, D. (2009) Comparison of the Keratometric Corneal Astigmatic Power after Phacoemulsification: Clear Temporal Corneal Incision versus Superior Scleral Tunnel Incision. Journal of Ophthalmology, 2009, Article ID: 210621.
[21]	Barequet, I., Yu, E., Vitale, S., Cassard, S., Azar, D.T. and Stark, W.J. (2004) Astigmatism Outcomes of Horizontal Temporal versus Nasal Clear Corneal Incision Cataract Surgery. Journal of Cataract Refractive Surgery, 30, 418-423. http://dx.doi.org/10.1016/S0886-3350(03)00492-9
[22]	Ernest, P., Hill, W. and Potvin, R. (2011) Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision. Journal of Ophthalmology, 2011, Article ID: 243170.
[23]	Ernest, P., Tipperman, R., Eagle, R., et al. (1998) Is There a Difference in Incision Healing Based on Location? Journal of Cataract Refractive Surgery, 24, 482-486. http://dx.doi.org/10.1016/S0886-3350(98)80288-5
[24]	ESCRS Endophthalmitis Study Group (2007) Prophylaxis of Postoperative Endophthalmitis Following Cataract Surgery: Results of the ESCRS Multicenter Study and Identification of Risk Factors. Journal of Cataract Refractive Surgery, 33, 978-988. http://dx.doi.org/10.1016/j.jcrs.2007.02.032
[25]	Henderson, B., Pineda, R., Ament, C., Chen, S. and Kim, J. (2007) Essentials of Cataract Surgery. Slack Incorporated, On Line Library.
[26]	Hill, W. and Potvin, R. (2008) Monte Carlo Simulation of Expected Outcomes with the AcrySof® Toric Intraocular Lens. BMC Ophthalmology, 8, 1-9. http://dx.doi.org/10.1186/1471-2415-8-22
[27]	Hayashi, K., Manabe, S., Yoshida, M. and Hayashi, H. (2010) Effect of Astigmatism on Visual Acuity in Eyes with a Diffractive Multifocal Intraocular Lens. Journal of Cataract Refractive Surgery, 36, 1323-1329. http://dx.doi.org/10.1016/j.jcrs.2010.02.016