Comparison of surgically induced astigmatism between horizontal and X‑pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery.

Background: Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X‑pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect. Aims: To compare SIA between horizontal and X‑pattern sutures in the scleral tunnel incisions for MSICS. Design: Prospective, nonrandomized comparative trial. Materials and Methods: After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X‑pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively. Statistical Analysis: The SIA was calculated by Cartesian coordinates based analysis. Results: Sixty‑four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against‑the‑rule astigmatism. In the X‑pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with‑the‑rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small. Conclusion: In the MSICS, the X‑pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.

Astigmatism after Cataract Surgery using Various Wound Sizes, Configurations, and Suture Techniques

We performed a retrospective review of three hundred and twelve consecutive patients who underwent phacoemulsification and posterior chamber lens implantation between January 1, 1990 and December 31, 1990. Patients were divided into three groups according to the wound size: 3.5 - 4.0 mm(95 patients); 5.0 - 5.5mm(74 patients) and 6.5 - 7.0mm(143 patients). The patients in the 3.5 to 4.0mm did not receive suture and the patients in the 5.0 to 5.5mm wound size received one horizontal suture. The patients in the 6.5 to 7.0mm group were further evaluated by comparing those who received two horizontal sutures with those who received a running shoelace suture. At one day, one week, one month, and one year after surgery, astigmatic error was measured and a vector analysis calculation of diopters of mean induced keratometric astigmatism was performed. There was a statistically significant increase in astigmatism following 6.5 to 7.0mm incision as compared to 3.5 to 5.5mm incision at each time interval. There was no significant difference in astigmatism at any time period between the 5.0 to 5.5mm and 3.5 to 4.0mm incision groups. The longer the incision, the greater the postoperative against-the-rule astigmatic shift at the last follow up. Among those of 6.5 - 7.0 wound size, the shoelace suture technique induced greater with-the-rule astigmatic change than two horisontal sutures at postoperative day one but the difference did no longer persist at one year.

Surgically Induced Astigmatism According to Corneoscleral Incision Length and Suture Methods After Cataract Surgery

We analyzed corneal astigmatic change on patients after phacoemulsification with scleral pocket incision, according to incision length and suture methods. The patients were divided into 4 groups and followed up at least for 2 months. The four groups were 5.5 mm incision length with horizontal suture technique group, 5.5 mm incision length with sutureless technique group, 6.5 mm - 7.0 mm incision length with horizontal suture technique group and 6.5 mm - 7.0 mm incision length withsutureless technique group. Inall groups, there was slightly increasing tendency of against the rule astigmatism, but less than 0.54 D(average). Among the patients with 5.5 mm incision length, horizontal suture group had almost the same astigmatic change as sutureless group(p=0.44, t-test), and with horizontal suture technique, 5.5 mm group had a tendency of less astigmatic change than 6.5 - 7.0 mm group(p=0.087, t-test), but without statistical significance.

The Change of Astigmatism After Cataract Extraction with Double Horizontal Suture

We analysed a series of cataract surgery cases into two groups. double horizontal suture group and shoelaces running suture group. We modified horizontal suture technique putting two separate sutures before opening the anterior chamber. Shoelaces running suture group showed early with-the-rule astigmatism about 2 diopter, which decayed over time reaching breakout point at 8 weeks, then very little change. Double horizontal suture group also showed early with-the-rule astigmatism, but the amount was less than half a diopter, which decayed over time, reaching break point at 4 yveek, stabilizing thereafter. After 8 weeks there was no statistical difference between two groups. In summary, double horizontal suture results in less astigmatism and therefore better visual acuity immediatedly after the surgery (p<0.005, student t-test) and for the first 2 months compared to shoelaces running suture.

The Change of Astigmatism After Cataract Extraction with Double Horizontal Suture

We analysed a series of cataract surgery cases into two groups. double horizontal suture group and shoelaces running suture group. We modified horizontal suture technique putting two separate sutures before opening the anterior chamber. Shoelaces running suture group showed early with-the-rule astigmatism about 2 diopter, which decayed over time reaching breakout point at 8 weeks, then very little change. Double horizontal suture group also showed early with-the-rule astigmatism, but the amount was less than half a diopter, which decayed over time, reaching break point at 4 yveek, stabilizing thereafter. After 8 weeks there was no statistical difference between two groups. In summary, double horizontal suture results in less astigmatism and therefore better visual acuity immediatedly after the surgery (p<0.005, student t-test) and for the first 2 months compared to shoelaces running suture.

Comparison of the Corneal Astigmatism Between Suture Methods After 7mm Scleral Pocket Incision Catartact Surgery

Most of cataract surgeons have made a great effort to minimize or nullify corneal 'astigmatism resulted from the incision and closure, but a completely ideal wound system still eludes us. The scleral pocket incision and continuous single knotted shoelace suture of it has been known as one of the technique for reducing postoperative astigmatism. Recently, horizontal suture closure of scleral pocket incisior has been introduced because it doesn't cause suture induced wound compression. We implanted standard PMMA intraocular lenses in the bag of 400 patients through 7mm scleral pocket incision following CCC (continuous circular capsulorhexis) and bimanual phacoemulsification. The incision was closed with either the shoelace or horizontal suture. The keratometric measurement was maded at postoperative 1 day, 1 week, 1 month, 2 month, 3 month and 6 month. In shoelace suture group, the preoperative corneal astigmatism appeared -0.14 +/- 0.15D of with the rule astigmatism (WTR); at one day postoperatively -2.75 +/- 1.61 of WTR, at 3 month 0.18 +/- 1.14D of against the rule astigmatism (ATR), 6 month 0.3 +/- 1.22D of ATR. In horizontal suture group, the preoperative corneal astigmatism appeared -0.22 +/- 1.22D of WTR; at one day postoperatively -1.05 +/- 1.28 of WTR, at 2 month 0.57 +/- 1.0 of ATR, at 6 month 0.72 +/- 1.91 of ATR. The difference between two suture methods was statistically significant (p<0.01 until 3 month, p<0.05 until 3-6 month).

Keratorefractive Aspect and Visual Performance of the Incision and Closure Method for Catatact Surgery

In order to evaluate the effect of incision length and suture method on astigmatic changes and visual acuity, three different cataract surgical procedures were carried out and compared retros pectively. Every sample used in this work showed better than 20/25 of corrected visual acuity after 8 weeks, postoperatively. The first group(30 eyes) had a single horizontal suture after phacoemulsification followed by implantation of a hydrogel lens through 4.0mm or ovoid polymethylmethacrylate(PMMA) lens through 5.2mm incision. The second group(30 eyes) had three interrupted sutures after phacoemulsification followed by implantation of PMMA lens through, 7.2mm incision. The third group(30 eyes) had five radial interrrupted sutures after a standard extracapsular cataract extraction(ECCE) through 10mm incision followed by implanta hon of PMMA lens. The suture material was 10-0 nylon in all samples. The astigmatism and visual acuity were assessed at one day, 1,2,4,6, and 8 weeks, postoperatively. Over 60% of the eyes in the first group showed an uncorrected visual acuity of 20/40 or better after 1 week, 43.3% of the second group and only 6.7% of the third group showed that acuity. The difference in keratomety measurement between 1 week and 8 weeks postoperatively was smallest in the first group and second group showed less difference than third group. It could be concluded that small incision and single horizontal suture technique showed significantly less astigmatism and faster visual rehabilitation than the other proecdures.