Surgically induced astigmatism and posterior corneal curvature changes following phacoemulsification

Purpose: To primarily compare surgically induced astigmatism (SIA), total and posterior corneal curvature, pachymetry, and their stabilization after 2.2 and 2.8 mm clear corneal incision in phacoemulsification. Methods: A randomized, prospective interventional study of 130 patients (130 eyes) of either sex having senile cataract (>40 years) divided randomly into two groups. The patients underwent uncomplicated phacoemulsification surgery with foldable intraocular lens implantation using 2.2 mm (group 1) and 2.8 mm incisions (group 2). The patients were evaluated preoperatively and followed?up at first, third, and sixth weeks. Results: Mean SIA was less in group 1 at all the follow?up visits which was not statistically significant (P value – 0.507 (at week 1), 0.626 (at week 3), and 0.312 (at week 6). Mean SIA decreased from week 1 to week 6 in both the groups. Both the groups showed an increase in SIA with the increase in the hardness of cataract. Posterior keratometry (k1 and k2) showed statistically significant steepening in the first postoperative week, followed by gradual flattening which continued till the sixth week postoperatively. Posterior astigmatism increased in both the groups at week 1 (not statistically significant). Thereafter, it decreases and does not change significantly after 3 weeks. Pachymetry increased significantly (P value < 0.001 in both the groups) in the first week in both the groups and thereafter stabilizing at 3 weeks. Conclusion: Reducing the incision size does not result in any significant reduction in SIA. We observed that the posterior corneal curvature majorly stabilized by 3 weeks, but some stabilization continued till 6 weeks.

Comparison of Visual Acuity and Surgically Induced Astigmatism after Phacoemulsification by Temporal Clear Corneal Incision & Superior Clear Corneal Incision

Background- The primary goal of cataract extraction surgery is immediate visual recovery and the best uncorrected visual acuity (UCVA) post operatively. Aim: To compare the surgically induced astigmatism (SIA) after phacoemulsification surgery with superior clear corneal incision (SCCI) and temporal clear corneal incision (TCCI). Materials & method: 11 articles were reviewed on PubMed related to SIA & a review was made on the factors that are responsible to reduce the post-operative astigmatism. The outcome measures were SIA and UCVA at 2 and 6 weeks, post?operatively. Results - In this study we expect to have better visual outcome and reduce incidence of SIA in TCCI than SCCI. Conclusion: TCCI appears to have better visual outcome and reduced incidence of SIA.

Effect of the inside mouth positions of clear corneal incisions of cataract on astigmatism after surgery was analysised using anterior segment optical coherence tomography / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the influencing factors of clear corneal incision(CCI)after phacoemulsification by Logistic regression analysis. <p>METHODS: A retrospective cases-control study was performed. 126 patients(138 eyes)who received phacoemulsification combined with implantation of foldable intraocular lens(IOL)were included in Erdos Central Hospital. Postoperative 1d, all of the CCIs were scanned by anterior segment optical coherence tomography(AS-OCT). According to whether there were presence of inner opening CCIs, the patients were divided into two groups. Group 1: inner opening CCIs(84 eyes)were absent. They were stable. Group 2: inner opening CCIs(54 eyes)were present. The factors affecting the stability of CCI were analyzed.<p>RESULT: The incidence of internal opening incisions was 39.1%(54/138). It decreased to 8.7%(12/138)at 1wk. One month postoperative, the internal mouths of the incisions were completely closed. The stability of the incisions was good. But AS-OCT scan found 3 cases with poor healing internal incisions. Binary Logistic regression analysis showed that age, incision length, incision angle, location of the internal incision, incision method and descemet's membrane detachment had statistically significant difference(<i>OR</i>=1.102, 0.994, 27.895, 0.127, 30.269, 6.750, all <i>P</i><0.05).<p>CONCLUSION:Age, incision length, incision angle, location of the internal incision, incision method and descemet's membrane detachment are the influencing factors of CCI stability after phacoemulsification.

Efficacy of Phaco combined with IOL implantation through 3.2mm transparent corneal incision in treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect of 3.2mm clear corneal incision cataract phacoemulsification combined with intraocular lens(IOL)implantation.<p>METHODS: Retrospective analysis of 95 cases(107 eyes)cataract patients treated in our hospital, and all patients were given 3.2mm clear corneal incision Phaco combined with IOL implantation. The postoperative visual acuity, corneal curvature, corneal astigmatism, anterior chamber depth and complications were observed.<p>RESULTS: Postoperative 3d, 1wk, 1mo patients with the uncorrected visual acuity(0.16±0.06, 0.15±0.05, 0.14±0.04)were significantly better than preoperative(0.48±0.15). The anterior chamber depth(3.86±1.09, 3.69±1.04, 3.84±1.07mm)was significantly higher than the preoperative(2.71±0.88mm)(<i>P</i><0.05), but there was no significant difference in corneal curvature and corneal astigmatism before operation. There was no difference in surgical astigmatism after operation(<i>P</i>>0.05).<p>CONCLUSION: 3.2mm clear corneal incision Phaco combined with IOL implantation can effectively improve the recovery of postoperative visual acuity and reduce the corneal astigmatism, and it is a safe and effective surgical treatment of cataract.

Effect of different clear corneal incision sites on surgery efficacy and anterior segment parameters in patients undergoing phacoemulsification / 南方医科大学学报

OBJECTIVE@#To determine the safe distance range of clear corneal incision (CCI) from the corneal limbus and how different CCI sites affect surgery efficacy and anterior segment parameters in patients undergoing phacoemulsification.@*METHODS@#This retrospective case-control study was conducted in 44 patients (44 eyes) undergoing phacoemulsification and IOL implantation. The patients were divided into two groups with CCI distances ranging from 1 mm to 1.5 mm (group A, = 22) and from 0.5 mm to 1.0 mm (group B, = 22). The visual acuity, surgically induced astigmatism (SIA), corneal aberration, and anterior segment parameters were analyzed.@*RESULTS@#Compared with the preoperative data, all the patients showed significant improvements in the postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and anterior chamber angle (ACA) after the surgery ( < 0.05). No significant differences were found between the two groups in postoperative UCVA, BCVA, SIA, total corneal aberration RMS, lower- and higher-order aberration RMS, spherical aberration (Z), horizontal three leaf clover (Z), vertical three leaf clover(Z), horizontal coma(Z), vertical coma(Z), ACD, ACA, anterior chamber volume, or central corneal thickness (>0.05).@*CONCLUSIONS@#Phacoemulsification is an effective therapy for cataract with a CCI distance range either of 1-1.5 mm or 0.5-1.0 mm. These two CCI distance ranges produce no significant differences in the visual quality following phacoemulsification, indicating that a CCI distance range of 0.5-1.5 mm can be safe for phacoemulsification.

Effect of 2.8mm clear corneal incisions in phacoemulsification on surgically induced corneal higher-order aberrations / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the changes of surgically induced corneal higher order aberrations after phacoemulsification with 2.8mm clear corneal incisions at different sites.METHODS:The clinical data of 100 cases (100 eyes) of patients with cataract treated by phacoemulsification with 2.8mm clear corneal incision in our hospital from March 2015 to April 2016 were analyzed retrospectively.According to the site of incision,they were divided into Group A (temporal clear corneal incision,n =55) and Group B (upper clear corneal incision,n=45).Changes of the best corrected visual acuity (BCVA),surgically induced astigmatism (SIA) and corneal topography were compared between the two groups before surgery,at 1d,1wk,1 and 3mo after surgery.The corneal wavefront aberrations were measured by wavefront aberration analyzer,and the changes of higher-order aberrations in corneal 6mm range were recorded.RESULTS:The BCVA of two groups decreased at 1d,1wk,1 and 3mo after surgery (P＜0.05),and the BCVA of Group A at 1d,1wk,and 1mo after surgery was lower than that of Group B (P＜0.05).SIA of the two groups decreased at 1wk,1 and 3mo after surgery (P＜0.05),and the SIA of Group A at different time points after surgery were lower than those of Group B (P＜0.05).The surface asymmetry index (SAI) and the surface rule index (SRI) of the two groups increased at 1 d after surgery,and were gradually decreased at 1wk,1 and 3mo after surgery.The SRI and SAI in Group A were lower than those in Group B at 1d and 1wk after surgery (P＜ 0.05).The total corneal higher-order aberrations (tHOAs) and four-order spherical aberration (SA)showed significant differences between the two groups at 3mo after surgery (P＜0.05).CONCLUSION:The application of 2.8mm temporal clear corneal incision in phacoemulsification can promote the recovery of visual acuity,reduce the effect of surgery on corneal shape,and reduce corneal higher-order aberrations.

Effects of different position of clear corneal incision of cataract surgery on visual function and quality of life / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To study the effects of different position of clear corneal incision of cataract surgery on visual function and quality of life. ?METHODS: ln this study, 126 cases (126 eyes) in our hospital from April 2013 to April 2014 were selected, who were accepted the transparent corneal incision phacoemulsification and intraocular lens implantation in treatment of senile cataract patients. With digital method were divided into observation group and control group with 63 cases in each group, included the observation group selected the maximum refractive power of the cornea radial axial transparent angle incision, and the control group in the temporal clear corneal incision, compared the two groups of patients with postoperative visual function ( VF) and quality of life ( QOL) , and made statistics of uncorrected visual acuity. ? RESULTS: ln the observation group, postoperative visual function and the scores of quality of life were 80. 3±5. 63 and 80. 9±0. 79, was significantly higher than the control group (74. 9±5. 24) and (76. 5±0. 76). And the postoperative uncorrected visual acuity of patients in the observation group was less than that of the control group, while ≤1. 0 of patients than that in the control group. There was statistically significantdifference (P ?CONCLUSlON: Transparent cornea in cataract surgery to choose the largest cornea diopter longitude as incision can effectively improve the therapeutic effect, especially on the visual function of patients and to improve the quality of life.

Small Incision Cataract Surgery (SICS) with Clear Corneal Incision and SICS with Scleral Incision – A Comparative Study.

Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS) with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3%) was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B) than in SICS with clear corneal incision (Group-A). Keywords: SICS; clear corneal incision; scleral incision; astigmatism.

Effect of micro - incision on corneal wavefront aberration and tear film in phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the effect of endocapsular phacoemulsification cataract extraction and intraocular lens (lOL) implantation with a 1. 8mm or 3. 0mm clear corneal incision on total root mean square ( RMS ) value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film. METHODS:ln a prospective study, 156 age- related patients ( 196 eyes ) were randomly distributed into two groups. 1. 8mm-group comprised 94 eyes that had a silicone lOL inserted through a 1. 8mm sutureless clear corneal incision, while, 3. 0mm- group comprised 102 eyes through a 3. 0mm clear corneal incision. Postoperatively, the changes in the total RMS value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film at 1wk, 1 and 3mo were determined respectively. RESULTS:ln both groups, postoperatively at 1wk,there were statistically significant differences ( P 0. 05 ) between two groups at 3mo postoperative. CONCLUSlON:This study confirms that incision size has strong impact on the corneal higher-order aberrations, especially, 3. 0mm incision caused significant differences in the total RMS value of cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film compared with 1. 8mm micro-incision, therefore, micro-incision is very beneficial for clinical use in phacoemulsification.

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

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.

Research in the effect of different cataract ultrasonic emulsification incision on the stability of the tear film after operation / 中国实用护理杂志

Objective To discuss the effect of different cataract ultrasonic emulsification incision on the stability of the tear film after operation.Methods 82 patients (149 eyes) in our hospital from January 2010 to December 2012 were adopted as the research object.Patients were randomly divided into group A (40 cases,72 eyes) and group B(42 cases,77 eyes) used stratified random block method.Patients in group B were treated with anti-eyebrow scleral tunnel incision,and patients in group A were treated with corneal incision.The subjective feeling,tear secretion,tear film break-up time and the corneal incision staining of patients were compared and the results were analyzed between two groups.Results There were statistically significant differences in the subjective feeling of patients,the amount of tear secretion and the tear film breakup time (BUT) between the first day and the seventh day after operation.Conclusions Anti-eyebrow scleral tunnel incision is an ideal incision method for phacoemulsification.It has less impact on the stability of the cornea,and the damage to nerve is also light.

The clinical analysis of corneal astigmatism changes after cataract surgery with different locations of clear corneal incision / 中国医师进修杂志

Objective To evaluate the corneal astigmatism changes after phacoemulsification performed using clear corneal incision with different locations.Methods Seventy-two eyes of 72 patients having phacoemulsification and implantation of foldable intraocular lens through a clear corneal incision were chosen.Patients were divided into two groups by table of random digit:group A (incision at 11:00),group B (incision at the steepest corneal meridian).The change of corneal astigmatism was compared between group A and B postoperatively.Surgically-induced astigmatism (SIA) was calculated by vector analyses using the HoHaday-Cravy-Koch method.Results Preoperative corneal astigmatism between group A and group B had no significant difference [(0.96 ± 0.52) D vs.(0.94 ± 0.56) D,P ＞ 0.05].One and three months after operation,the corneal astigmatism in group A were significantly higher than those in group B [(1.15 ± 0.32)D vs.(0.82 ± 0.43) D,(0.85 ± 0.38) D vs.(0.63 ± 0.40) D,P＜ 0.05].The SIA in group A was significantly higher than that in group B 1 month after operation [(0.85 ± 0.37) D vs.(0.75 ± 0.54) D,P ＜ 0.05],there was no significant difference between group A and group B 3 months after operation [(0.60 ±0.35) D vs.(0.58 ±0.30) D,P ＞0.05].Conclusions Corneal astigmatism is prｅsent in most cataract surgery candidates.Cataract surgery using steepest corneal meridian incision induces significantly less SIA,and correct corneal astigmatism already present preoperatively.

Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques

PURPOSE: In the present study we compared the intraocular pressure (IOP) after cataract surgery according to incisional techniques. METHODS: Patients who underwent phacoemulsification with intraocular lens implantation were divided into 2 groups: clear corneal incision group (CC group), and scleral tunnel incision group (ST group). All complicated cases were excluded. IOP was measured preoperatively and at 1 week, 1, 3, 6, 12, 18 and 24 months after surgery. RESULTS: Seventy-seven patients (100 eyes) were enrolled in the present study; CC group (28 patients, 33 eyes), ST group (49 patients 67 eyes). Preoperative IOPs in both groups were not significantly different (p = 0.908, student's t-test). IOP in the CC group at 1 week after surgery significantly decreased 2.22 +/- 2.57 mm Hg compared to preoperative IOP (p < 0.001, repeated-measures ANOVA with post hoc analysis), and the IOP of the ST group decreased 2.11 +/- 2.50 mm Hg (p < 0.001, repeated-measures ANOVA with post hoc analysis). The lowered IOP was maintained for 24 months postoperatively. There was no significant difference in IOP change after surgery depending on incisional techniques (p = 0.848, repeated measures ANOVA). CONCLUSIONS: There may be no difference in IOP lowering effect after surgery depending on incisional techniques.

Comparison between the Wong Incision and stromal hydration of corneal incisions in phacoemulsification

Objective@#To determine the efficacy of the Wong incision in providing wound seal compared to stromal wall hydration in clear cornea phacoemulsification in cadaveric porcine eyes.@*Method@#This was an in vitro comparative experimental study using ten porcine eyes. All eyes were randomly assigned to the stromal wall hydration (control) or the Wong incision group (experimental). A side port was made and the anterior chamber formed with viscoelastic device. The main incision was made 180 degrees away. In the experimental group, a Wong incision was made first anterior to the main incision. Phacoemulsification surgery with IOL insertion was simulated. The main incision was sealed by hydration. The anterior chamber (AC) was infused with balanced salt solution (BSS) through an AC maintainer and leakage of fluid from the main incision was assessed. Samples from the AC were taken before and after tryphan blue drip and were sent for analysis by UV spectrophotometry. Trypan blue was dripped over the main incision and the whole eyeball was sent for histopathology.@*Results@#There was a significant increase in density from the pre-dye to the post-dye AC samples of the control (0.0052 to 0.0074, p=0.01) and the experimental groups (0.0076 to 0.0094, p=0.02), although the final samples showed an optical density comparable to pure BSS, indicating that there was no significant amount of trypan blue detected in both groups. On histology, trypan blue staining was not seen in the incision tracts of both groups. After infusing the AC with BSS, there was outward wound leakage in all eyes of the control group and none in the experimental group.@*Conclusion@#The Wong incision was as effective as the lateral stromal wall hydration in preventing fluid influx. Furthermore, the Wong incision showed a more stable wound seal against outward wound leakage in an in-vitro porcine model of clear corneal phacoemulsification.

Steep Axis Incision Versus Temporal Incision in Microcoaxial Cataract Surgery

PURPOSE: To determine if a difference exists in surgically-induced astigmatism (SIA) and the mean change in keratometric astigmatism in patients who underwent microcoaxial cataract surgery (MCCS). METHODS: A prospective study including 193 eyes with astigmatism of greater than 0.5 diopters was performed. The eyes were randomized into two groups: (1) 95 eyes with steep axis incision, and (2) 98 eyes with temporal incision. A 2.2-mm microcoaxial phacoemulsification was performed. The UCVA, BCVA and corneal topography (Orbscan II, Bausch & Lomb) were measured preoperatively and three months postoperatively. Surgically induced astigmatism was calculated via vector analysis, and the mean change in keratometric astigmatism was also calculated. RESULTS: There were no significant differences in UCVA or BCVA between the two groups three months postoperative. The mean SIA was 0.45 +/- 0.27 diopters in the steep axis incision group and 0.30 +/- 0.17 diopters in the temporal incision group. In the steep axis incision group, the mean keratometric astigmatism showed a mean reduction of 0.31 +/- 0.37 diopter (WTR: 0.37 D; oblique: 0.35D; ATR: 0.16 D), while the mean keratometric astigmatism showed a mean increase of 0.06 +/- 0.29 diopters (WTR: 0.15 D increased; oblique: 0.11 D increased; ATR: 0.13 D reduced) in the temporal incision group. There were statistically significant differences in SIA and change in astigmatism between the two groups (p = 0.002, p = 0.000). CONCLUSIONS: In MCCS, steep axis incision achieved superior astigmatism correction in patients having with-the-rule or oblique astigmatism of greater than 0.5 diopters.

The Short Term Effects of a Single Limbal Relaxing Incision Combined with Clear Corneal Incision

PURPOSE: To compare the effects of performing a single limbal relaxing incision (LRI) combined with a clear corneal incision on a corneal astigmatism with that of paired LRIs in cataract surgery. METHODS: Medical records for 25 eyes in 20 patients who had undergone LRIs during cataract operations for with-the-rule astigmatism of 1.5 diopters (D) or more in topography were retrospectively reviewed. Single or paired LRIs were assigned randomly and were performed on the steepest axis; the degrees of arc were determined using the modified Gills nomogram. A clear corneal wound was made on the steepest vertical axis. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and corneal astigmatism on topography were evaluated preoperatively and one month postoperatively. Naeser's polar value analysis was used to assess the efficacy of the LRIs. RESULTS: The mean depth of the LRIs and degrees of arc were 620+/-31 micrometer (87.1% of corneal thickness) and 56.84+/-19.68degrees, respectively. The mean postoperative UCVA and BCVA (log MAR) were significantly improved (0.51+/-0.37 and 0.09+/-0.12, respectively) (p<0.05). Average refractive and corneal astigmatisms were significantly reduced by 49.4 percent and 32.4 percent, respectively (p<0.05). The single LRI combined with clear corneal incision showed reduced efficacy in refractive astigmatism by 47 percent, which is similar to that of paired LRIs where a 48 percent reduction in efficacy was seen. CONCLUSIONS: The short-term effects of a single LRI combined with clear corneal incision on a corneal astigmatism appears to be as effective as performing paired LRIs when combined with cataract incision.

A Phacovitrectomy with a Clear Corneal Incision for a Full-Thickness Macular Hole

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p<0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808+/-0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Comparison of Scleral Tunnel and Clear Cornea Incision in Phacoemulsification Combined with Pars Plana Vitrectomy

PURPOSE: To compare the results of two different incision METHODS: scleral tunnel vs clear cornea in cases phacoemulsification and posterior chamber intraocular lens implantation combined with pars plana vitrectomy. METHODS: Between August 2003 and August 2005, 61 eyes with cataract and vitreoretinal diseases were treated by phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative best-corrected visual acuity (BCVA), astigmatism change, and complications were analyzed. RESULTS: The mean age of patients in the scleral tunnel incision (Group 1) and clear corneal incision (Group 2) was 57.09+/-13.72 and 58.83+/-11.83 years respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 82% of Group 1 and 78% of Group 2. There was a significant difference in the postoperative astigmatic changes between Group 1 and 2 (1.37+/-1.13D vs 0.78+/-0.67D). No discernible differences such as recurrent vitreous hemorrhage, inflammation in anterior chamber, increased intraocular pressure or iris changes were noted between the two groups. CONCLUSIONS: Although there was no difference in the postoperative BCVA, two different incision methods yielded significant different postoperative astigmatic changes.

The Comparison of Corneal Sensitivity after Temporal and Superior Clear Corneal Incisions in Cataract Surgery

PURPOSE: To compare the change in corneal sensitivity after temporal and superior clear corneal incisions in cataract surgery. METHODS: We measured and compared the change in corneal sensitivity in senile cataract patients who had received phacoemulsification using temporal clear corneal incision (group 1) and superior clear corneal incision (group 2). The changes were measured at 1 week, 1 month, and 3 months after surgery using Cochet-Bonnet esthesiometer. RESULTS: There were 25 eyes (20 patients) in group 1 and 25 eyes (23 patients) in group 2. The mean age for each group was 67.2 +/- 8.6 years and 63.0 +/- 6.6 years, respectively. At 1 week after surgery, the sensitivity at the corneal center had a tendency to be decreased in both groups (Group 1: P=0.057, Group 2: P=0.043). No significant changes were observed during the subsequent follow-up period. There were significant decreases in the sensitivity at the incision site in both groups. At 3 months after surgery, the corneal sensitivity was nearly recovered to preoperative values. The postoperative change in corneal sensitivity showed similar patterns in both groups, and group 1 showed a larger decrease. CONCLUSIONS: Postoperative change in corneal sensitivity occurs mainly around the incision site and is recovered to preoperative values within 3 months after surgery.

Correction of with-the-rule Astigmatism by Superior Clear Corneal Incision and Transverse Keratotomy in Cataract Surgery

PURPOSE: The effect of superior clear corneal incision and transverse astigmatic keratotomy on the with-the-rule astigmatism in sutureless, small incision cataract surgery was evaluated. METHODS: The postoperative keratometric changes were evaluated in 18 eyes with more than 1.4 diopter (D) of preoperative with-the-rule astigmatism, having sutureless, superior clear corneal incision phacoemulsification. Five eyes over 2.8 D with-the-rule astigmatism also had transverse corneal relaxing incision. Keratometric readings were done within 1 month preoperatively, 1 day and 2 months postoperatively and the changes were statistically analyzed. Simple subtraction method and Cravy method were used for the analysis of astigmatic changes. RESULTS: The mean astigmatism showed decreasing trend, 2.08, 2.25, 1.12 D, within preoperative 1 month, at postoperative 1 day and 2 months respectively and 3.70, 2.48, 2.06 D respectively when transverse keratotomy was added. The reduction of astigmatism was statistically significant at postoperative 2 months (P<0.05; Wilcoxon rank-sum test) and it was more significant with transverse astigmatic keratotomy (P<0.05, Mann-Whitney U test). CONCLUSIONS: The with-the-rule astigmatism over 1.40 D could be reduced in cataract surgery by sutureless, superior clear corneal incision and transverse corneal relaxing keratotomy.