Abstract :
Introduction: Cataract surgery now, is not just rehabilitative surgery but therapeutic also, as patient wants
to be ridden off glasses. Surgically induced astigmatism (SIA) is the cause of poor post-operative vision
even af ter uneventful cataract surgery.
Aims and Methodology: The aim of study was to compare the astigmatic outcomes and incision integrity
in 5.5mm temporal clear corneal incision (TCCI) and superior scleral incision (SSI) in phacoemulsification
surgery. A total of 200 eyes were included. Cases were randomly divided in two groups. Group A
underwent phacoemulsification with TCCI and Group B with SSI, of 5.5mm length. Patients were followed
up on post operative day (POD)1,8,40,90,180 Postoperative astigmatism was recorded by keratometry, SIA
was analyzed by SIA Software and incision integrity observed by slit lamp examination.
Results: Mean Post-operative astigmatism in TCCI group was 0.90, 0.87, 0.79, 0.75, 0.73D on POD
1, 8, 40, 90, 180 respectively, and that in SSI group was 1.43, 1.37, 1.28, 1.24, 1.24D. It was low in
TCCI group and statistically significant. Mean SIA in group A was 1.13(0.59), 1.15(0.5), 0.99(0.42),
0.92(0.44), 0.90(0.46) on POD1, 8, 40, 90 and180. The change from POD1 to 40 was significant
and there was no further significant change in SIA upto 6months. In group B, SIA was 0.9 2(0.48),
0.92(0.39), 0.80(0.34), 0.75(0.30) and 0.76(0.36) on POD1, 8, 40, 90 and 180. The change from 1st
to 40th day was significant and there was mild decrease in SIA on POD 90 and POD 180 but not significant
compared to POD 40.
Conclusion: Though SIA was high and statistically significant in TCCI group but postoperative
astigmatism was less and statistically significant. There was significant WTR shift in postoperative
astigmatism in TCCI group and ATR in SSI group. Large incision size of upto 5.5mm clear corneal incision
can have self-sealing properties hence dismissing the use of suture.
Keyword :
Astigmatic outcomes Incision integrity, Postoperative astigmatism surgically induced astigmatism.