Hyun Seung Kim, M.D.Department of Ophthalmology, St. Mary’s hospital,

The Catholic University of Korea

Changes in Astigmatism After Clear Corneal

Temporal Incision Cataract Surgery

in With-The-Rule Astigmatism Patient

IntroductionIntroduction

Inserting the IOL in the bag

Capsule bag diameter < Total IOL length

→ Angulation between IOL optic and haptic may occur

→ IOL angulation might induce astigmatism

perpendicular to the inserted axis.

PurposePurpose

This study is to compare changes of with-the-rule

astigmatism after clear corneal temporal incision

cataract surgery in with-the-rule astigmatic patients.Suturing temporal incision vs. not suturing

IOL haptic insertion at 180° vs. 90° axis

Materials and MethodsMaterials and Methods 47 patients (49 eyes) with grade 3 cataract

Operation procedure 3 mm clear corneal temporal incision with a diamond blade Phacoemulsification of the lens nucleus was performed with

phacoemulsifier (Infiniti, Alcon, USA). IOL (One-piece AcrySof®, SA60AT, Alcon Laboratories,

Forth Worth, TX, USA ; total length 13.0 mm) was inserted in the bag.

After placing the IOL in the bag, IOL rotation was performed to place the haptic axis at 180°or 90°.

IOL haptic insertion axis was randomly selected. Incision suture was performed with 10-0 nylon (one radial

suture), randomly. It was removed at postoperative 1 month.

Materials and MethodsMaterials and Methods Patients were divided into four groups according to IOL haptic

insertion axis and incision suture Group I : IOL haptic axis at 180°+ Incision suture done. Group II : IOL haptic axis at 90°+ Incision suture done. Group III : IOL haptic axis at 180°+ Incision suture not done. Group IV : IOL haptic axis at 90°+ Incision suture not done.

Astigmatic changes were compared by Autorefractor (BK-F1, Canon) and Topography (Orbscan II, Orbtek) at preoperative and postoperative 1 day, 1 week, 1 month, 2 months.

Pupil dilatation was done at postoperative 1 month and patients with IOL rotation from the original insertion axis were excluded from the study.

Dermographics Dermographics and preoperative astigmatismand preoperative astigmatism

Group I Group II Group III Group IV P-value

Eye 12 11 12 14

Age 59.36±11.79 45.60±16.86 55.67±12.32 58.57±13.59 0.319

Gender( F : M )

7 : 5 5 : 6 8 : 4 6 : 8

Autorefractor: Cylinder (D)

1.70±1.38 1.43±0.76 0.96±0.91 1.53±1.36 0.461

Topography: Sim K’s (D)

1.67±0.52 1.02±0.62 0.88±0.54 1.48±0.26 0.110

Results Results – Suture vs. No suture– Suture vs. No suture

Suture Group(Group I+II)

No suture Group(Group III+IV)

P-value

Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.54±1.101.25±0.681.09±0.691.20±0.881.20±0.86

1.27±1.131.40±1.301.23±1.091.29±1.061.33±1.02

0.9710.0160.0260.8080.061

Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.55±1.151.35±0.891.52±0.931.44±0.90

1.21±0.791.53±1.071.51±1.081.49±1.11

0.4660.0360.5850.446

Results Results – Suture vs. No suture– Suture vs. No suture

Preop 1 week 1 month 2 months0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2(A)

*

Top

ogra

phy

: Sim

K's

(D

)

Time after surgery

Suture No Suture

Preop 1 day 1 week 1 month 2 months-0.6

-0.8

-1.0

-1.2

-1.4

-1.6

-1.8

-2.0

-2.2

-2.4

-2.6

* *

(B)

Aut

oref

ract

or :

Cyl

inde

r (D

)Time after surgery

**

Aut

oref

ract

or :

Cyl

inde

r

Suture No Suture

Topography : Corneal astigmatism tends to increase in no suture group, as an relaxing effect of temporal incision. There are no statistical significance between two groups, except at postoperative 1 week (A).

Autorefractor : Refractive astigmatism tends to decrease in suture group at postoperative 1 day, 1 week, 1 month and 2 months. Astigmatism showed significant difference between two groups at postoperative 1 day and 1 week, but it showed no difference at postoperative 1 month and 2 months (B).

Results Results – Haptic 180°vs. Haptic 90° – Haptic 180°vs. Haptic 90°

Haptic 180°

(Group I+III)

Haptic 90°

(Group II+IV)P-value

Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.32±1.171.28±1.001.00±0.731.01±0.771.01±0.81

1.46±1.091.39±1.151.34±1.091.49±1.111.53±1.30

0.9710.6210.0510.0500.048

Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.40±1.141.34±0.881.42±0.951.29±0.97

1.30±0.791.56±1.111.61±1.071.65±1.05

0.4660.5370.5850.446

Results Results – Haptic 180°vs. Haptic 90°– Haptic 180°vs. Haptic 90°

Preop 1 week 1 month 2 months0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2(A)

*

**

Top

ogra

phy

: Sim

K's

(D

)

Time after surgery

Haptic 180o

Haptic 180o

Preop 1 day 1 week 1 month 2 months-0.6

-0.8

-1.0

-1.2

-1.4

-1.6

-1.8

-2.0

-2.2

-2.4

-2.6(B)

* * *

Au

tore

fra

cto

r : C

ylin

de

r (D

)

Time after surgery

Haptic 180o

Haptic 90o

Topography : There are no statistical difference between two groups (A). Autorefractor : Refractive astigmatism of group with IOL haptic insertion axis at 180˚showed

significant difference compared to the group with IOL haptic insertion axis at 90˚at postoperative 1 week, 1 month and 2 months. It was also significantly decreased in group with IOL haptic axis at 180˚compared with preoperative astigmatism at postoperative 1 week, 1 month and 2 months (B).

Results Results – Group comparison– Group comparison

Group I Group II Group III Group IV

Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.70±1.381.32±0.751.23±0.761.25±0.831.25±0.74

1.43±0.761.17±0.590.92±0.561.14±0.941.14±0.98

0.96±0.911.25±1.180.79±0.650.79±0.650.79±0.82

1.53±1.361.54±1.381.61±1.251.71±1.151.79±1.41

Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months

1.67±0.521.50±1.001.67±1.081.53±1.08

1.02±0.621.16±0.691.34±0.671.32±0.59

0.88±0.541.20±0.731.18±0.751.07±0.78

1.48±0.261.81±1.231.79±1.231.86±1.22

Results Results – Group comparison– Group comparison

Preop 1 day 1 week 1 month 2 months0.0

-0.2

-0.4

-0.6

-0.8

-1.0

-1.2

-1.4

-1.6

-1.8

-2.0

* * *

*** *

Au

tore

fra

cto

r : C

ylin

de

r (D

)

Time after surgery

Group I Group II Group III Group IV

Preop 1 week 1 month 2 months0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6

*

***

To

po

gra

ph

y : S

im K

's (

D)

Time after surgery

Group I Group II Group III Group IV

ConclusionsConclusionsWhen performing cataract surgery in with-the-rule astigmatism

patientsSuturing the temporal incision may reduce WTR astigmatism

comapred with not suturing the incision.

Inserting the IOL haptic axis at 180°may have an effect of

reducing WTR astigmatism compared with IOL inserted at 90°

axis.

Further clinical study is needed.Compare the results with ATR astigmatic patients.

Difference between angulation of IOL haptic inserted at 90°or

180°and difference between IOL types.