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.