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Background: Cataract surgery and intraocular lens implantation restores near normal visual acuity in otherwise healthy eyes, safe surgery, postoperative emmetropia and early resuming of normal activities are three major considerations of present day cataract surgery. Aim: To evaluate and compare surgically induced altered refractive status following superior versus temporal incision in small incision cataract surgery. Materials and methods: 100 cases of cataract surgery were selected for study of post-operative refractive status in superior versus temporal incision in cataract surgery. A complete ocular examination including anterior and posterior segment examination and general physical examination was performed in all cases. Results: Majority (75%) of patients of the present study who underwent cataract extraction belonged to age group of above 50 years with maximum preponderance in the age group of between 61-70 years. The minimum amount of astigmatism one week after surgery in Group – 2 was 0.5D and the maximum amount was 6.0D. The average amount of astigmatism one week after surgery in Group – 2 was 2.75D. The minimum amount of astigmatism 6 weeks after surgery in Group – I was 0.25D and maximum amount was 4.0D. The minimum amount of astigmatism 6 weeks after surgery in Group – Giridhar Bellamkonda, Sri Kavya. Factors affecting post-operative astigmatism in superior and temporal approaches in Manual Small Incision Cataract Surgery. IAIM, 2018; 5(3): 44-54. Page 45 2 was 0.25D and maximum amount was 2.0D. The complications were seen in early postoperative period more in superior incision group than in temporal group. Astigmatism was cleared in temporal group when compared to superior incision group. After 6 weeks of postoperative follow-up, visual acuity of every patient was recorded after giving proper pseudophasic correction. Temporal Incision had 92% 6/6 -6/9 and 6/12-6/18 visual acuity. Conclusions: Amount of astigmatism was less in temporal incision SICS than superior incision SICS. The postoperative refractive status, is also good in temporal incision SICS than superior incision SICS.
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Introduction: Globally cataract is the major cause for blindness. About 75% of cases preventable causes of blindness in developing countries are attributed to cataract. As per available literature so many studies are available to study how to control the surgically induced astigmatism in variety of cataract surgeries. In the current study we aimed to focus on the effect of factors like wound modulation, and also role of superior or temporal scleral tunnel incisions on the post-operative astigmatism. Objective: To study the effect of wound modulation on postoperative astigmatism following manual small incision suture less scleral tunnel cataract surgery by either superior or temporal incision. Materials and methods: The study was a hospital based quasi experimental study, conducted in the department of ophthalmology at NRI Medical College and General Hospital, Chinakakani, Andhra Pradesh state from August 2014 to August 2015. A total of 100 randomly selected subjects undergoing cataract surgery by suture less non phaco small incision sclera tunnel technique were included. Results: 36% of the patients included in this study for superior small incision sutureless non phaco cataract surgery pre operatively had with the rule astigmatism and 42% had against the rule astigmatism and no astigmatism is seen in 22% of cases. Pre operatively 34% of the patients included Chimata T, Tirumuru D, Chowdary NL. A study of the effect of wound modulation on postoperative astigmatism following manual small incision suture less scleral tunnel cataract surgery. IAIM, 2016; 3(7): 345-352. Page 346 in this study for temporal small incision suture less non phaco cataract surgery had with the rule astigmatism and 48% had against the rule astigmatism and no astigmatism is seen in 18% of cases. In cases subjected to superior small incision suture less non-phaco cataract surgery showed against the rule astigmatism and in 72% and with the rule in 20% and no astigmatism in 4% of cases. In cases subjected to temporal small incision suture less cataract surgery had surgically induced astigmatism of with the rule in 84% and only 8% had against the rule and no astigmatism was found in 8% of cases. At six weeks 86% of cases subjected to superior small incision suture less non –phaco cataract surgery had surgically induced astigmatism of against the rule type and in 12% with the rule type and 2% had no astigmatism. In cases subjected to temporal small incision suture less non-phaco cataract surgery there was surgically induced astigmatism of with the rule type in 86% of cases ad 8% of against the rule type and 6% had no astigmatism. In cases subjected to temporal suture less non – phaco small incision cataract surgery induced astigmatism by 3 weeks was 0.69D in with the rule type and 0.31D in against the rule type and the average total was about 0.66D. By 6 weeks the mean surgically induced astigmatism in superior SICS was 0.71D in with the rule type and 1.51D in against the rule type and an average of 1.01D in total. In cases subjected to temporal SICS it was 0.69D in with the rule type and 0.33D in against the rule type and a total of 0.66 D by 6 weeks. Conclusion: Temporal small incision cataract surgeries shows less induced astigmatism whereas superior small incision cataract surgeries higher SIAS values.
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Background: Location of incision has a significant impact on surgical outcome. It has been reported that temporal incisions induce less astigmatism than superior incisions indicating the importance of incision location. The objective of the present study was to study the effect of surgical induced astigmatism in superior versus temporal incision in small incision cataract surgery cases. Methods: 100 patients of cataract attending to Sarojini Devi eye hospital with the rule and against the rule astigmatism were included in the study. The astigmatic profile and the effect of surgical incision on astigmatism were studied. A prospective study was done in which patients were divided into two groups. MSICS was performed with superiorly located incision in group I and temporally located incision in group II. Results: Out of the total 100 patients undergoing MSICS, 59 patients had ATR, 36 patients had WTR and 5 patients had no astigmatism. Thus the pre-operative astigmatic profile shows that ATR is more common type of astigmatism in this group. Among 50 patients in superior incision group, 18 had pre-operative WTR, 29 had ATR and 3 did not have astigmatism. Postoperatively the no. of patients with WTR decreased to 10, the no. of patients with ATR increased to 35 showing that superior incision flattens vertical meridian and steepens the horizontal meridian causing ATR shift. Among 50 patients in temporal incision group, 18 had pre-operative WTR, 30 had ATR and 2 did not have astigmatism. Post operatively the no of patients with WTR increased to 25, the no of patients with ATR decreased to 20. Conclusions: Placement of incision on steep axis reduces pre-existing astigmatism. Thus in ATR astigmatism it is placed temporally and in WTR astigmatism it is placed superiorly. Thus a simple modification in incision placement can minimize surgically induced astigmatism and reduce pre-existing astigmatism.
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Aims: To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery. Materials and Methods: This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes). The outcome measures were surgically induced astigmatism (SIA) and uncorrected visual acuity (UCVA) 1 and 3 months, post‑operatively. Results: At 1 month, the mean SIA was 0.81 diopter (D) for the temporal incisions and 0.92 D for nasal incisions (P = 0.139). At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309). The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post‑operatively. Conclusion: After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less) would be favorable for astigmatism‑neutral cataract surgery.
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PURPOSE: This study was conducted to compare post-operative astigmatic outcomes of two groups, with-the-rule (WTR) and against-the-rule (ATR) astigmatism patients, according to the haptic axis of intraocular lenses (IOLs) inserted in cataract surgery. METHODS: Seventy-two eyes with WTR astigmatism and 79 eyes with ATR astigmatism had cataract surgery through a clear corneal temporal incision. These two groups of eyes were then each divided into 2 groups based on whether the haptic axis of the inserted IOL was at 180degrees or 90degrees. For ATR patients, the outcomes were analyzed according to the three types of IOLs. RESULTS: There was no difference in corneal astigmatism, but WTR patients with a 180degrees haptic axis of the inserted IOL and ATR patients with a 90degrees hepatic axis of the inserted IOL had a significant decrease in postoperative refractive astigmatism (p < 0.05). The changes in ATR astigmatism according to the IOL type were more effective in single-piece acrylic IOLs than in the three-piece polymethylmethacrylate haptic IOL group. CONCLUSIONS: Insertion of the IOL at the 180degrees haptic axis in WTR patients and at 90degrees in ATR patients during cataract surgery may have an effect in reducing pre-existing astigmatism. This observed effect was not consistent among the different types of IOLs.
Subject(s)
Humans , Astigmatism/classification , Cataract Extraction/adverse effects , Equipment Design , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Postoperative Complications , Treatment OutcomeABSTRACT
PURPOSE: The effect of suture presence or position of intraocular lens was evaluated on the astigmatic changes in cataract patients suffering from with-the-rule astigmatism who underwent temporal clear corneal incision cataract surgeries. METHODS: According to the presence or absence of suture and the lens position (either 180degrees or 90degrees), 49 eyes of 47 patients were divided into four groups. Astigmatism was determined using an autorefractor and by topography before surgery, and at one day, one week, one month, and two months after surgery. RESULTS: The suture group showed significant reduction in astigmatism at postoperative day 1 and week 1 by autorefractor and topography compared with the non-suture group. The group with intraocular lens insertion axis at 180degrees did not show significant reduction of astigmatism by autorefractor evaluation. Astigmatism determination by topography in this group was 1.00+/-0.73D, 1.01+/-0.77D and 1.01+/-0.81D at postoperative week 1, month 1, and month 2, respectively, and this showed significant reduction of astigmatism compared with preoperative astigmatism (1.32+/-1.17D) and group with intraocular lens insertion axis at 90degrees. In particular, the group with the sutured temporal incision and with an inserted intraocular lens axis at 180degrees showed significant reduction of astigmatism by autorefraction. CONCLUSIONS: When performing cataract surgery in with-the-rule astigmatism patients, suturing the temporal incision and inserting the intraocular lens axis at 180degrees can reduce astigmatism and minimize the effect of surgically-induced astigmatism.
Subject(s)
Humans , Astigmatism , Axis, Cervical Vertebra , Cataract , Eye , Lenses, Intraocular , Stress, Psychological , SuturesABSTRACT
This study was carried out to evaluate corneal astigmatism according to distance between the limbus and internal lip after temporal incision cataract surgery. Twenty-five eyes of patients undergoing routine phacoemulsification with one plate haptic silicone IOL(STAAR)posterior chamber lens implantation with 3.0 mm temporal scleral pocket incision and sutureless method by one surgeon were randomly selected. Corneal astigmatism was evaluated at postoperative first day, first week, second week, first month, second month and analyzed by the Cravy s vector method. Internal lip length 1.0 mm group showed 0.11 diopter aganist-the-rule change of corneal astigmatism at the first week and 0.11 diopter with-therule change at the third month and internal lip length 1.5 mm group showed 0.16 diopter aganist-the-rule change of corneal astigmatism at first week and 0.04 diopter agaist-the-rule change at the third month but these differences were not statistically significant(students t-test:p>0.05). In this study we found that if a distance between the limbus and internal lip has longer than 1.0 mm, it was not an important factor on influencing the surgically induced astigmatism and could get wound stability after sutureless cataract sugery using a watertight scleral tunnel incision.
Subject(s)
Humans , Astigmatism , Cataract , Lip , Phacoemulsification , Silicones , Wounds and InjuriesABSTRACT
This study was carried out to evaluate the effect of electrocauterization on corneal astigmatism after cataract operation with temporal incision. Forty-two eyes of patients undergoing routine phacoemulsification with one piece type polymethymethacrylate(PMMA) posterior chamber lens implantation with 6.0mm temporal scleral pocket incision and sutureless method by one surgeon were randomly selected Corneal astigmatism was evaluated for postoperative 3 months and analyzed by Cravy`s vector method. Both groups(electrocauterization group and no electrocauterization group) showed slight with-the-rule change of corneal astigmatism till postoperative 3 months and electrocauterization group showed +0.31D at postoperative 3 months but these differences were not statistically significant(student`s t-test: p=1.10). This results demonstrate that the scleral electrocauterization at temporal incision site induced more with-the-rule change than no cauterization group.
Subject(s)
Humans , Astigmatism , Cataract , Cautery , PhacoemulsificationABSTRACT
We analysed postoperative corneal astigmatic changes to know that preoperative astigmatism was able to decreased according to the location of incision in sutureless cataract surgeries. We divided 70 patients, 81 eyes that scleral pocket incision, phacoemulsification, and posterior chamber intraocular lens implantation was performed into two groups. The one is the preoperative with-the-rule(WTR)astigmatism more than 1 diopter(D) with superior incision, and the other is the preoperative WTR less than 1D or against-the-rule (ATR) astigmatism with temporal incision. We followed up the corneal astigmatic chnges until six months postoperatively. According to the results of algebraic analysis, in the superior incision group, postoperative astigmatic changes showed WTR decrease of 0.43D immediately, which advanced toward ATR decrease of 0.41D immediately, which keep up ATR decrease and showed ATR decrease of 0.44D at 6 months. According to the results of vector analysis, surgical inducced corneal astigmatism was o.69D in superior incision group and 0.50D in temporal incision group at postoperative 1day. It was 0.98D in superior incision group and 0.57D in temporal incision group at postoperative 6 months. We could decrease preoperative corneal astigmatism with performing incision at the position of greater corneal curvature. Temporal incision group showed less surgical induced astigamatic changes than superior incision.
Subject(s)
Humans , Astigmatism , Cataract , Lens Implantation, Intraocular , PhacoemulsificationABSTRACT
A group of 25 preoperative against-the-rule(AR) eyes had undergone phacoemulsification and posterior chamber lens implantation, 15 of them prepared with lateral(temporal) scleral pocket incision and 10 with superior scleral incision. Temporal incision group showed early AR astigmatism increment by about 1 diopter(D), which decayed slowly over the next 2 months. Superior incision group showed early with-the-rule (WR) astigmatism by about 2.5D, which shifted toward AR astigmatism at postoperative 10 day and the AR astigmatism increased substantially by the next 2 months. The early postoperative complications were hyphema(2 eyes, 13.3%) and corneal edema(1 eye, 6.7%) in the temporal incision group, which cleared spontaneously within 1 week pctoperative. There were no hyphema and corneal edema in the superior incision group. In summary, the temporal incision effectively achived rapid post-operative astigmatic recovery with strong axial stability in a manner that surgically induced astigmatism favorably reduces pre-existing AR astigmatism.